Provider Demographics
NPI:1306084074
Name:SCROGGINS, BETHANY STENSON (PTA)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:STENSON
Last Name:SCROGGINS
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:PO BOX 1141
Mailing Address - Street 2:
Mailing Address - City:SUNRAY
Mailing Address - State:TX
Mailing Address - Zip Code:79086-1141
Mailing Address - Country:US
Mailing Address - Phone:806-948-1853
Mailing Address - Fax:
Practice Address - Street 1:115 W 1ST ST
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029-2405
Practice Address - Country:US
Practice Address - Phone:806-934-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2012853225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant