Provider Demographics
NPI:1386061703
Name:FORSHAW, BETHANY (MS, ATC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:FORSHAW
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 MULLEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1908
Mailing Address - Country:US
Mailing Address - Phone:860-460-0066
Mailing Address - Fax:
Practice Address - Street 1:37 MULLEN HILL RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1908
Practice Address - Country:US
Practice Address - Phone:860-460-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-6341662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer