Provider Demographics
NPI:1104228865
Name:BETHEA, JOE JR
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:BETHEA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E NORTHSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-2328
Mailing Address - Country:US
Mailing Address - Phone:843-423-8335
Mailing Address - Fax:
Practice Address - Street 1:600 E NORTHSIDE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-2328
Practice Address - Country:US
Practice Address - Phone:843-423-8335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor