Provider Demographics
NPI:1356319073
Name:GRAF, BETH NICOLE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:NICOLE
Last Name:GRAF
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 S BLUCKSBERG DR
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-2803
Mailing Address - Country:US
Mailing Address - Phone:715-566-0224
Mailing Address - Fax:
Practice Address - Street 1:2398 5TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-2340
Practice Address - Country:US
Practice Address - Phone:715-566-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9954-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist