Individual
BETH ERICA NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
665 W JACKSON ST, WOODSTOCK, IL 60098-3187
(815) 334-8850
(815) 334-8853
Mailing address
665 W JACKSON ST, WOODSTOCK, IL 60098-3187
(815) 334-8850
(815) 334-8853
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070013612
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05627401
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/13/2008
Last updated
08/13/2008
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