Provider Demographics
NPI:1447447099
Name:EARLEY, BETH ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:EARLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:COOPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7540 N 19TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:888-873-4221
Mailing Address - Fax:888-543-2289
Practice Address - Street 1:620 HARPER AVE
Practice Address - Street 2:WHISPERING OAKS CARE CENTER
Practice Address - City:PESTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157
Practice Address - Country:US
Practice Address - Phone:715-582-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI249019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40212600Medicaid