Provider Demographics
NPI:1427861806
Name:WIJESINGHE, BETHANY MALLEY (LMBT, BA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MALLEY
Last Name:WIJESINGHE
Suffix:
Gender:F
Credentials:LMBT, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:WOODFIN
Mailing Address - State:NC
Mailing Address - Zip Code:28804-7502
Mailing Address - Country:US
Mailing Address - Phone:612-834-2165
Mailing Address - Fax:
Practice Address - Street 1:25 REED ST STE 201
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3078
Practice Address - Country:US
Practice Address - Phone:612-834-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15446225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist