Provider Demographics
NPI:1730658063
Name:BEAULIEU, ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BEAULIEU
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 1:714 KLEVE ST
Mailing Address - Street 2:
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-9759
Mailing Address - Country:US
Mailing Address - Phone:715-651-9595
Mailing Address - Fax:
Practice Address - Street 1:2815 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-2656
Practice Address - Country:US
Practice Address - Phone:715-723-9341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2803-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant