1356139687 NPI number — DR. BETHANY DEBRA KARKER PT, DPT

Table of content: DR. BETHANY DEBRA KARKER PT, DPT (NPI 1356139687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356139687 NPI number — DR. BETHANY DEBRA KARKER PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARKER
Provider First Name:
BETHANY
Provider Middle Name:
DEBRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356139687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2547 ANGEL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULF BREEZE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32563-5552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-741-6715
Provider Business Mailing Address Fax Number:
850-741-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2547 ANGEL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULF BREEZE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32563-5552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-741-6715
Provider Business Practice Location Address Fax Number:
850-741-6715
Provider Enumeration Date:
04/28/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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