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NPI Code Detail

MEDICARE: BETHANY CHEYANNE GREEN LMT

MEDICARE: BETHANY CHEYANNE GREEN 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
1225700000XMassage Therapist2025-4227WV

General Provider Information

NPI Number : 1811873318
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY CHEYANNE GREEN LMT
Provider Business Mailing Address
First Line : 811 HARRISON ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3008
Country : US
Telephone Number : 304-960-1408
Fax Number :
Provider Business Practice Location Address
First Line : 1307 MERCER ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-3033
Country : US
Telephone Number : 304-960-1408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2025
Last Update Date : 08/12/2025

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Directions to “ BETHANY CHEYANNE GREEN LMT” Practice Location

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