Individual
MR. JASON WILLIAM BETHEA SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
11 BROADWAY # 433, NEW YORK, NY 10004-1303
(646) 413-4930
Mailing address
11 BROADWAY # 433, NEW YORK, NY 10004-1303
(646) 413-4930
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
032412
NY
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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