Provider Demographics
NPI:1184820102
Name:PIKE, BETH T (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:T
Last Name:PIKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:813 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-2940
Mailing Address - Country:US
Mailing Address - Phone:727-785-8728
Mailing Address - Fax:
Practice Address - Street 1:30522 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 110
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4444
Practice Address - Country:US
Practice Address - Phone:727-789-6008
Practice Address - Fax:727-789-0716
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA14230225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant