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General NPI Number Information
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NPI Number | 1417633124
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Entity Type | Individual
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Provider Name | BETHANY ANNE ADAMS PTA
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 208 STONE ST
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City | RIPLEY
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State | WV
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Zip | 25271-1162
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Country | US
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Telephone | 304-372-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 714 BOSO AVE
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City | RAVENSWOOD
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State | WV
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Zip | 26164-1412
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Country | US
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Telephone | 304-532-8138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 000891
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License Number State | WV
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