Individual
BETHANY D RICHERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
165 NATCHEZ TRACE AVE, STE 200, BOWLING GREEN, KY 42103-7940
(270) 796-4698
(270) 782-3274
Mailing address
165 NATCHEZ TRACE AVE, STE 200, BOWLING GREEN, KY 42103-7940
(270) 796-4698
(270) 782-3274
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004243
KY
225100000X
Physical Therapist
05007579A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000280266
BLUE CROSS BLUE SHIELD
IN
01
—
000000590928
BLUE CROSS BLUE SHIELD
KY
05
—
200839570
—
IN
Enumeration date
12/08/2005
Last updated
07/02/2013
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