Provider Demographics
NPI:1649393273
Name:ROSSOW, BETH MARIE (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:ROSSOW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 THEATRE RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8679
Mailing Address - Country:US
Mailing Address - Phone:608-392-5004
Mailing Address - Fax:608-392-5791
Practice Address - Street 1:191 THEATRE RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8679
Practice Address - Country:US
Practice Address - Phone:608-392-5004
Practice Address - Fax:608-392-5791
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6422054-2401225100000X
WI11422-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT466502Medicare ID - Type Unspecified