Provider Demographics
NPI:1003851668
Name:RAITZ REX, BETH ANN (MS, ATC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANN
Last Name:RAITZ REX
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ROBSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2117
Mailing Address - Country:US
Mailing Address - Phone:859-781-5609
Mailing Address - Fax:
Practice Address - Street 1:2751 O'VARSITY WAY
Practice Address - Street 2:ROOM 265
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45221-0001
Practice Address - Country:US
Practice Address - Phone:513-556-3939
Practice Address - Fax:513-556-0691
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer