Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | J1-0000933 | DE |
N | 2251S0007X | Physical Therapist - Sports | J3-0000066 | DE |
N | 2251X0800X | Physical Therapist - Orthopedic | JI-0000933 | DE |
NPI | 1366573933 |
---|---|
Provider Name | Christopher S Bethard |
First Address | Wilmington, DE 19810-4581 |
Second Address | Dover, DE 19904-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0751198000 | IBC (01) | |
11220683 | CAQH (01) | |
1366573933 | CHAMPUS (01) | |
1366593933 | (05) | DE |
5070-0071 | CAREFIRST (01) | |
88760518 | NCA (01) |