Provider Demographics
NPI:1043016280
Name:PORTER, BETHANY (PT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PORTER
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 VANTAGE WAY STE 330
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1550
Mailing Address - Country:US
Mailing Address - Phone:615-649-5432
Mailing Address - Fax:
Practice Address - Street 1:8319 HIGHWAY 22 STE A
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:TN
Practice Address - Zip Code:38225-2416
Practice Address - Country:US
Practice Address - Phone:731-364-5554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7623225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist