Individual
BETH ANN DENNISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
341 S LINCOLN ST APT 4, BLOOMINGTON, IN 47401-2705
(812) 369-9910
Mailing address
4123 W SIERRA DR, BLOOMINGTON, IN 47403-5138
(812) 369-9910
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21405186
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT21405186
MASSAGE THERAPY
IN
Enumeration date
04/16/2019
Last updated
04/16/2019
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