MEDICARE: BETHANY LYNN EVERSON PT

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	225100000X	Physical Therapist	PT007036	OH

General Provider Information

NPI Number	:	1700401940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY LYNN EVERSON PT

Provider Business Mailing Address
First Line	:	357 NATHAN DR
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-7483
Country	:	US
Telephone Number	:	614-679-4885
Fax Number	:

Provider Business Practice Location Address
First Line	:	8849 WHITNEY DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-7107
Country	:	US
Telephone Number	:	614-679-4885
Fax Number	:

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

Provider Enumeration Date	:	06/13/2020
Last Update Date	:	06/13/2020

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