Provider Demographics
NPI:1609936095
Name:NORDSTROM, BETH AMY (PT)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:AMY
Last Name:NORDSTROM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:AMY
Other - Last Name:JINKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0590
Mailing Address - Country:US
Mailing Address - Phone:406-446-1112
Mailing Address - Fax:406-446-0082
Practice Address - Street 1:600 W 21ST ST.
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068
Practice Address - Country:US
Practice Address - Phone:406-446-1112
Practice Address - Fax:406-446-0082
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist