Individual
BETHANY DALE WIRSIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3747 SW RAINTREE DR, LEES SUMMIT, MO 64082-4606
(816) 537-5650
(816) 537-5649
Mailing address
17134 BEL RAY PL, BELTON, MO 64012-5331
(816) 226-4011
(816) 524-6115
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2012023674
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47471021
BCBS KC
—
01
—
MA4370034
MEDICARE PTAN
MO
Enumeration date
04/30/2012
Last updated
02/17/2014
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