MEDICARE: BETHANN PATRICIA VETTER LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	MA22362	FL

General Provider Information

NPI Number	:	1174810956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANN PATRICIA VETTER LMT

Provider Business Mailing Address
First Line	:	2902 ISABELLA BLVD
Second Line	:	SUITE 50
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8005
Country	:	US
Telephone Number	:	904-707-5029
Fax Number	:	904-241-7132

Provider Business Practice Location Address
First Line	:	2902 ISABELLA BLVD
Second Line	:	SUITE 50
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-8005
Country	:	US
Telephone Number	:	904-707-5029
Fax Number	:	904-241-7132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/30/2011

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