Individual
BETH MICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT, ATC
Contact information
Practice address
5 BON AIR RD, SUITE 129, LARKSPUR, CA 94939-1143
(415) 307-0866
Mailing address
5 BON AIR RD, SUITE 129, LARKSPUR, CA 94939-1143
(415) 307-0866
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
37400
CA
Other
Enumeration date
02/09/2011
Last updated
02/09/2011
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