Healthcare Provider Details

I. General information

NPI: 1407289572
Provider Name (Legal Business Name): ABBEY BETLACH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 E QUEEN CREEK RD #109
GILBERT AZ
85297-8503
US

IV. Provider business mailing address

2450 W PECOS RD #3044
CHANDLER AZ
85224-4863
US

V. Phone/Fax

Practice location:
  • Phone: 480-621-8361
  • Fax:
Mailing address:
  • Phone: 515-681-6294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number10490
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: