Healthcare Provider Details

I. General information

NPI: 1437482064
Provider Name (Legal Business Name): BETH ANNE CHAMPLIN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

IV. Provider business mailing address

709 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-6412
  • Fax:
Mailing address:
  • Phone: 814-563-6412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007381L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: