Provider Demographics
NPI:1578666103
Name:THIEL, BETSY SILLECK (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:SILLECK
Last Name:THIEL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:856 N SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8299
Practice Address - Country:US
Practice Address - Phone:219-213-3942
Practice Address - Fax:219-213-3943
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018271225100000X
IN05001624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90000585OtherBCBS IL
IN200061430 AMedicaid
IN650019377OtherMEDICARE RR
IN000000091272OtherBCBS IN
IL1396775078OtherMEDICARE GROUP
IN650019377OtherMEDICARE RR