Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | PT001131E | PA |
Y | 2251N0400X | Physical Therapist - Neurology | PT001131E | PA |
N | 2251P0200X | Physical Therapist - Pediatrics | PT001131E | PA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT001131E | PA |
NPI | 1033624846 |
---|---|
Provider Name | Beth Gustafson |
First Address | Erie, PA 16505-4034 |
Second Address | Erie, PA 16505-4034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2017 |
Last Update Date | 04/12/2017 |