Provider Demographics
NPI:1073172110
Name:KING, BETH ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:KING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SE 10TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-3571
Mailing Address - Country:US
Mailing Address - Phone:605-556-0175
Mailing Address - Fax:605-556-0162
Practice Address - Street 1:411 SE 10TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-3571
Practice Address - Country:US
Practice Address - Phone:605-556-0175
Practice Address - Fax:605-556-0162
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist