Provider Demographics
NPI:1174810956
Name:VETTER, BETHANN PATRICIA (LMT)
Entity type:Individual
Prefix:
First Name:BETHANN
Middle Name:PATRICIA
Last Name:VETTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 ISABELLA BLVD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-8005
Mailing Address - Country:US
Mailing Address - Phone:904-707-5029
Mailing Address - Fax:904-241-7132
Practice Address - Street 1:2902 ISABELLA BLVD
Practice Address - Street 2:SUITE 50
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-8005
Practice Address - Country:US
Practice Address - Phone:904-707-5029
Practice Address - Fax:904-241-7132
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA22362172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist