Individual
MRS. BETSY SILLECK THIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
856 N SUPERIOR DR, CROWN POINT, IN 46307-8299
(219) 213-3942
(219) 213-3943
Mailing address
33900 HARPER AVE, STE 104, CLINTON TOWNSHIP, MI 48035-4258
(586) 350-2644
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001624
IN
225100000X
Physical Therapist
070018271
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000091272
BCBS IN
IN
01
—
1396775078
MEDICARE GROUP
IL
05
—
200061430 A
—
IN
01
—
650019377
MEDICARE RR
IN
01
—
90000585
BCBS IL
IL
Enumeration date
09/07/2006
Last updated
11/18/2021
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