Provider Demographics
NPI:1962877613
Name:MURRAY, BETHANY (LMT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MURRAY
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 1:2226 ESSEX DR APT B
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4888
Mailing Address - Country:US
Mailing Address - Phone:843-458-2313
Mailing Address - Fax:
Practice Address - Street 1:3260 HOLMESTOWN RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7489
Practice Address - Country:US
Practice Address - Phone:843-668-4225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7323225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist