Provider Demographics
NPI:1447489083
Name:CLARK, BETH A (DPT)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:CLARK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:N757 BIG KEGAMA RD
Mailing Address - Street 2:
Mailing Address - City:SARONA
Mailing Address - State:WI
Mailing Address - Zip Code:54870-9037
Mailing Address - Country:US
Mailing Address - Phone:715-651-1838
Mailing Address - Fax:
Practice Address - Street 1:15735 W US HIGHWAY 63
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6475
Practice Address - Country:US
Practice Address - Phone:888-834-4551
Practice Address - Fax:715-598-4881
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist