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NPI Code Detail

MEDICARE: BETHANY PETERSON PT, DPT

MEDICARE: BETHANY PETERSON PT, DPT
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
1225100000XPhysical Therapist11-05180KS

General Provider Information

NPI Number : 1689296865
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY PETERSON PT, DPT
Provider Business Mailing Address
First Line : 9616 LOWELL AVE
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66212-3304
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 E 63RD ST STE G10
Second Line :
City : KANSAS CITY
State : MO
Zip : 64110-3305
Country : US
Telephone Number : 913-575-8529
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2020
Last Update Date : 05/11/2020

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Directions to “ BETHANY PETERSON PT, DPT” Practice Location

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