Provider Demographics
NPI:1992794697
Name:KNOESPEL, BETTY JOY (PTA)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JOY
Last Name:KNOESPEL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JASPER ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:ID
Mailing Address - Zip Code:83313-5086
Mailing Address - Country:US
Mailing Address - Phone:208-788-4075
Mailing Address - Fax:
Practice Address - Street 1:314 S RIVER ST
Practice Address - Street 2:
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8426
Practice Address - Country:US
Practice Address - Phone:208-788-6312
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA 256225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant