Provider Demographics
NPI:1023285491
Name:LAXTON, BETH S (PT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:S
Last Name:LAXTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12182 EXCELSIOR RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:53518-4902
Mailing Address - Country:US
Mailing Address - Phone:608-537-2026
Mailing Address - Fax:
Practice Address - Street 1:101 SUNSHINE BLVD
Practice Address - Street 2:
Practice Address - City:SOLDIERS GROVE
Practice Address - State:WI
Practice Address - Zip Code:54655-7106
Practice Address - Country:US
Practice Address - Phone:608-624-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1453-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist