Provider Demographics
NPI:1912177411
Name:NICHOLSON, BETH MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:MARIE
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1122 W DIVIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1202
Mailing Address - Country:US
Mailing Address - Phone:406-585-1002
Mailing Address - Fax:701-258-1041
Practice Address - Street 1:1122 W DIVIDE AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-1202
Practice Address - Country:US
Practice Address - Phone:701-258-5058
Practice Address - Fax:701-258-1041
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist