Individual
BETHANY BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
782 WEATHERLY DR, CLARKSVILLE, TN 37043-8941
(931) 645-3552
Mailing address
782 WEATHERLY DR, CLARKSVILLE, TN 37043-8941
(931) 645-3552
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6449
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
136412159
DRIVERS LICENSE
TN
Enumeration date
05/10/2019
Last updated
06/11/2019
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