Provider Demographics
NPI:1497734248
Name:JOHNSEY, BETH A (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:A
Last Name:JOHNSEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-1750
Mailing Address - Country:US
Mailing Address - Phone:307-587-9866
Mailing Address - Fax:307-587-9867
Practice Address - Street 1:1819 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3886
Practice Address - Country:US
Practice Address - Phone:307-587-9866
Practice Address - Fax:307-587-9867
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY102379902Medicaid
WY308040OtherBLUE CROSS BLUE SHIELD
WY102379902Medicaid