1730182163 NPI number — HOWARD & TIBBETTS PHYSICAL THERAPY, INC.

Table of content: DR. BRITTANY ELISE BETHEA PHARMD, RPH (NPI 1588303168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730182163 NPI number — HOWARD & TIBBETTS PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD & TIBBETTS PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1730182163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4615 SCOTTS VALLEY DR
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
SCOTTS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95066-4278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-438-4478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13350 WEST PARK AVE
Provider Second Line Business Practice Location Address:
STE A2
Provider Business Practice Location Address City Name:
BOULDER CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-338-4458
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TIBBETTS
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
831-438-4478

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)

  • Identifier: ZZZ60815ZZ . This is a "BLUE SHIELD ID #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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