Provider Demographics
NPI:1679840037
Name:STANGE, BETH MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MARIE
Last Name:STANGE
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 1:2926 WELLINGTON DR E
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-0748
Mailing Address - Country:US
Mailing Address - Phone:715-835-2999
Mailing Address - Fax:
Practice Address - Street 1:215 E BROWN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WI
Practice Address - Zip Code:54722-9346
Practice Address - Country:US
Practice Address - Phone:715-286-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4915-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist