Provider Demographics
NPI:1194572479
Name:DIORIO, BETHANY LYNN (PTA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYNN
Last Name:DIORIO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:ACUSHNET
Mailing Address - State:MA
Mailing Address - Zip Code:02743-1003
Mailing Address - Country:US
Mailing Address - Phone:508-985-8687
Mailing Address - Fax:
Practice Address - Street 1:65 BOSTON POST RD W STE 130
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1855
Practice Address - Country:US
Practice Address - Phone:508-481-5519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7722225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant