MEDICARE: MRS. BETHANY MARIE LOUDER 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	1201968	TX

General Provider Information

NPI Number	:	1902731755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY MARIE LOUDER DPT

Provider Business Mailing Address
First Line	:	6604 SAPPHIRE CIR S
Second Line	:
City	:	COLLEYVILLE
State	:	TX
Zip	:	76034-6284
Country	:	US
Telephone Number	:	214-529-0539
Fax Number	:	817-960-6366

Provider Business Practice Location Address
First Line	:	810 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2504
Country	:	US
Telephone Number	:	817-960-6565
Fax Number	:	817-960-6366

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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