Provider Demographics
NPI:1831227354
Name:MICHAEL, BETH T (PT)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:T
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1120 FAIRMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-5414
Mailing Address - Country:US
Mailing Address - Phone:901-762-6386
Mailing Address - Fax:901-761-7171
Practice Address - Street 1:4692 SPOTTSWOOD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4822
Practice Address - Country:US
Practice Address - Phone:901-761-0555
Practice Address - Fax:901-761-7171
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8782251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440957Medicaid