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NPI Code Detail

MEDICARE: BETHANY PANNIER RBT

MEDICARE: BETHANY PANNIER RBT
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
1106S00000XBehavior TechnicianRBT-19-84565CO

General Provider Information

NPI Number : 1356904619
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY PANNIER RBT
Provider Business Mailing Address
First Line : 3535 PARKMOOR VILLAGE DR # 2
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-5292
Country : US
Telephone Number : 719-232-3498
Fax Number :
Provider Business Practice Location Address
First Line : 3535 PARKMOOR VILLAGE DR
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-5292
Country : US
Telephone Number : 719-232-3498
Fax Number : 719-325-8994
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2019
Last Update Date : 04/22/2019

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