Provider Demographics
NPI:1396282315
Name:BETHEL, JUSTIN SCOTT (CMT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:SCOTT
Last Name:BETHEL
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1484 HARTNELL AVE
Mailing Address - Street 2:STE H
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2252
Mailing Address - Country:US
Mailing Address - Phone:530-355-7404
Mailing Address - Fax:
Practice Address - Street 1:1484 HARTNELL AVE
Practice Address - Street 2:STE H
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2252
Practice Address - Country:US
Practice Address - Phone:530-355-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-28
Last Update Date:2017-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist