Provider Demographics
NPI:1174325690
Name:BEITLICH, JOANNE (PT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BEITLICH
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:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:STODDARD
Mailing Address - State:WI
Mailing Address - Zip Code:54658-0133
Mailing Address - Country:US
Mailing Address - Phone:602-992-1648
Mailing Address - Fax:
Practice Address - Street 1:3770 EMERALD DR E
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-4303
Practice Address - Country:US
Practice Address - Phone:608-615-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16235-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist