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General NPI Number Information
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NPI Number | 1417765447
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Entity Type | Organization
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Legal Business Name | BETHANY NELSON PT DPT LLC
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 313 DIVIDEND DR STE 300
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1934
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Country | US
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Telephone | 404-488-5342
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Fax |
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Provider Business Mailing Address
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Address Line | 526 BROOKS WOOLSEY RD
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-7030
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Country | US
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Telephone | 404-488-5342
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | DR. BETHANY LYNN NELSON
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Credential | PT, DPT
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Telephone | 404-488-5342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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