Provider Demographics
NPI:1194437418
Name:BROWN, BETHANY
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 ALLIANCE DR STE D
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8837
Mailing Address - Country:US
Mailing Address - Phone:317-821-3740
Mailing Address - Fax:317-821-3750
Practice Address - Street 1:10701 ALLIANCE DR STE D
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8837
Practice Address - Country:US
Practice Address - Phone:317-821-3740
Practice Address - Fax:317-821-3750
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2024-08-01
Deactivation Date:2023-08-28
Deactivation Code:
Reactivation Date:2024-08-01
Provider Licenses
StateLicense IDTaxonomies
IN05013993A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist