Provider Demographics
NPI:1932955119
Name:ALBRITTON, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ALBRITTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67-220 NIUMALOO PL
Mailing Address - Street 2:
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791-9507
Mailing Address - Country:US
Mailing Address - Phone:858-232-2674
Mailing Address - Fax:
Practice Address - Street 1:67-220 NIUMALOO PL
Practice Address - Street 2:
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791-9507
Practice Address - Country:US
Practice Address - Phone:858-232-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI318225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant