Basic Information
| Provider Information | |||||||||
| NPI: | 1194276014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOWIKOWSKI | ||||||||
| FirstName: | BETH | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2011 CORONA RD | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652032548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5766035138 | ||||||||
| FaxNumber: | 8662841178 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 60TH ST | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531403986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626584125 | ||||||||
| FaxNumber: | 2626582186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2016 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2520-19 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.