Provider Demographics
NPI:1366566929
Name:MUCKLER, BETH (DPT)
Entity type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:MUCKLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 N SEELEY AVE
Mailing Address - Street 2:1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1314
Mailing Address - Country:US
Mailing Address - Phone:773-556-5504
Mailing Address - Fax:
Practice Address - Street 1:6300 N RIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1017
Practice Address - Country:US
Practice Address - Phone:773-273-3040
Practice Address - Fax:773-973-4292
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70015586225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics