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General NPI Number Information
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NPI Number | 1477157675
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Entity Type | Individual
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Provider Name | BETHANY M WILSON LMT
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Gender | Female
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Dates
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Enumeration Date | 11/28/2020
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 2085 HENRY TECKLENBURG DR STE 100
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City | CHARLESTON
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State | SC
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Zip | 29414-7710
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Country | US
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Telephone | 843-958-2613
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Fax | 843-402-2652
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Provider Business Mailing Address
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Address Line | 2085 HENRY TECKLENBURG DR STE 100
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City | CHARLESTON
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State | SC
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Zip | 29414-7710
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Country | US
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Telephone | 843-958-2613
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Fax | 843-402-2652
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 6845
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License Number State | SC
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