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General NPI Number Information
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NPI Number | 1366570947
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Entity Type | Individual
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Provider Name | BETH M PACOCHA AUER PT, MPT
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 525 LINCOLN HWY SUITE 28
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2142
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Country | US
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Telephone | 618-622-5180
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Fax | 618-622-5169
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Provider Business Mailing Address
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Address Line | 1377 MOTOR PKWY STE 307
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City | ISLANDIA
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State | NY
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Zip | 11749-5258
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Country | US
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Telephone | 631-580-5200
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Fax | 631-580-5222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2006033635
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070014335
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License Number State | IL
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