MEDICARE: BETHANY J HUEBNER 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
1	225100000X	Physical Therapist	05009912A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000064558	OTHER	IN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000622157	OTHER	IN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1861620643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY J HUEBNER DPT

Provider Business Mailing Address
First Line	:	7300 E INDIANA ST
Second Line	:	SUITE 102
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-2794
Country	:	US
Telephone Number	:	812-476-0409
Fax Number	:	812-476-1016

Provider Business Practice Location Address
First Line	:	4421 N 1ST AVE
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47710-3621
Country	:	US
Telephone Number	:	812-759-3001
Fax Number	:	812-401-9013

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	11/09/2010

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