Provider Demographics
NPI:1811965767
Name:SCHMELLING, BETH ELLEN (PT)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ELLEN
Last Name:SCHMELLING
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:W4424 DAVEY LN
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-8960
Mailing Address - Country:US
Mailing Address - Phone:715-536-1585
Mailing Address - Fax:
Practice Address - Street 1:3401 CRANBERRY BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-5217
Practice Address - Country:US
Practice Address - Phone:715-393-2086
Practice Address - Fax:715-393-2105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3924-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41226200Medicaid