Provider Demographics
NPI:1851603765
Name:BEYER, GRETCHEN L (DPT)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:BEYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:DEGROOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:W234S3555 STATE ROAD 59
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8512
Mailing Address - Country:US
Mailing Address - Phone:262-532-5820
Mailing Address - Fax:
Practice Address - Street 1:W234S3555 STATE ROAD 59
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8512
Practice Address - Country:US
Practice Address - Phone:262-532-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400097664Medicare PIN
WI830420033Medicare PIN
WI832070024Medicare PIN