Provider Demographics
NPI:1669641221
Name:DOERRFELD, BETH D (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:D
Last Name:DOERRFELD
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 1:528 BLUFF ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6102
Mailing Address - Country:US
Mailing Address - Phone:815-395-1753
Mailing Address - Fax:815-227-1095
Practice Address - Street 1:528 BLUFF ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6102
Practice Address - Country:US
Practice Address - Phone:815-395-1753
Practice Address - Fax:815-227-1095
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant