Individual
MRS. BETHANY ALTA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
2025 E NEWPORT AVE, MILWAUKEE, WI 53211-2906
(414) 961-4666
Mailing address
1720 E CAPITOL DR, #212, SHOREWOOD, WI 53211-1951
(414) 234-6130
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
693-039
WI
Other
Enumeration date
02/21/2006
Last updated
07/08/2007
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