Provider Demographics
NPI:1669420352
Name:BETHKE, CHERYL ANN (PT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:BETHKE
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 1:1252 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5806
Mailing Address - Country:US
Mailing Address - Phone:530-622-9410
Mailing Address - Fax:
Practice Address - Street 1:1252 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5806
Practice Address - Country:US
Practice Address - Phone:530-622-9410
Practice Address - Fax:530-622-9445
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14686OtherPHYSICAL THERAPY LICENSE
CAPT14686OtherPHYSICAL THERAPY LICENSE