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NPI Code Detail

MEDICARE: MRS. BETH SOBCZAK III PT

MEDICARE: MRS. BETH SOBCZAK III PT
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
12251P0200XPediatric Physical Therapist3210-024WI

General Provider Information

NPI Number : 1922020122
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETH SOBCZAK III PT
Provider Business Mailing Address
First Line : 4210 N FARWELL AVE
Second Line :
City : SHOREWOOD
State : WI
Zip : 53211-1755
Country : US
Telephone Number : 414-961-2300
Fax Number :
Provider Business Practice Location Address
First Line : 1125 N 13TH ST
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53081-3281
Country : US
Telephone Number : 920-208-9648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 07/08/2007

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