MEDICARE: MRS. BETH NICOLE GRAF MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	9954-024	WI

General Provider Information

NPI Number	:	1356319073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH NICOLE GRAF MPT

Provider Business Mailing Address
First Line	:	8140 S BLUCKSBERG DR
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2803
Country	:	US
Telephone Number	:	715-566-0224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2398 5TH AVE STE 101
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-2340
Country	:	US
Telephone Number	:	715-566-0224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/01/2010

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