Individual
BETHANY A VANDIVORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
23155 23RD AVE W, BRIER, WA 98036-8383
(425) 835-1747
Mailing address
23155 23RD AVE W, BRIER, WA 98036-8383
(425) 835-1747
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
08/20/2021
Last updated
08/20/2021
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