Individual
BETHANY SUZANNE D'ANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
9715 HEALTHWAY DR, BERLIN, MD 21811-3500
(410) 641-4400
(410) 641-0011
Mailing address
6815 WHETSTONE DR, HEBRON, MD 21830-1149
(410) 860-5871
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
17652
MD
314000000X
Skilled Nursing Facility
J1000974
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17652
LICENSE NUMBER
MD
01
—
J1000974
LICENSE NUMBER
DE
Enumeration date
03/16/2007
Last updated
07/08/2007
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