Provider Demographics
NPI:1992287387
Name:ERTZBERGER, BETHA HUNNICUTT (CPED)
Entity type:Individual
Prefix:
First Name:BETHA
Middle Name:HUNNICUTT
Last Name:ERTZBERGER
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 ARMSTRONG PARK DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4889
Mailing Address - Country:US
Mailing Address - Phone:704-747-6579
Mailing Address - Fax:
Practice Address - Street 1:2905 VETERANS MEMORIAL HWY STE 2
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7655
Practice Address - Country:US
Practice Address - Phone:631-619-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist