Provider Demographics
NPI:1407289572
Name:BETLACH, ABBEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:BETLACH
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 1:2450 W PECOS RD
Mailing Address - Street 2:#3044
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4863
Mailing Address - Country:US
Mailing Address - Phone:515-681-6294
Mailing Address - Fax:
Practice Address - Street 1:3341 E QUEEN CREEK RD
Practice Address - Street 2:#109
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8503
Practice Address - Country:US
Practice Address - Phone:480-621-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ104902251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics