Provider Demographics
NPI:1326363151
Name:EBERTS, BETSY JO (LMT)
Entity type:Individual
Prefix:MS
First Name:BETSY
Middle Name:JO
Last Name:EBERTS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6396 6TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9677
Mailing Address - Country:US
Mailing Address - Phone:772-562-5689
Mailing Address - Fax:
Practice Address - Street 1:755 27TH AVE SW
Practice Address - Street 2:#1
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4200
Practice Address - Country:US
Practice Address - Phone:772-567-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA #6828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist