Individual
BETHANY SHADLE
Active
Individual
BETHANY SHADLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
40QA01174500
NJ
225100000X
Physical Therapist
Primary
PT013389
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00466045
RAILROAD MEDICARE
NJ
Enumeration date
10/15/2007
Last updated
12/27/2011
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