Provider Demographics
NPI:1467583757
Name:JANISH, BETH MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:JANISH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 ZION ST NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3524
Mailing Address - Country:US
Mailing Address - Phone:763-236-8934
Mailing Address - Fax:763-236-8930
Practice Address - Street 1:3111 124TH AVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-1793
Practice Address - Country:US
Practice Address - Phone:763-236-8934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant