Active NPI
Bethany Anne Tabieros, DPT
- Physical Therapist
- West Allis, WI
National Provider Identifier
1326060419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10644-024
- Practice address
- 8901 W Lincoln Ave Ste 405
West Allis, WI 53227 - Phone
- (414) 329-5658
- NPI assigned
- Jul 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 10644-024 | WI | Primary |
Addresses
Primary practice location
8901 W Lincoln Ave Ste 405
West Allis, WI 53227
Mailing address
3301 W Forest Home Ave
Milwaukee, WI 53215-2843
Phone (414) 389-2338
Other practice location 1
2500 W. Layton Ave
Ste 160
Milwaukee, WI 53221
Phone (414) 389-3023
Other practice location 2
4202 W Oakwood Park Ct Ste 310
Franklin, WI 53132
Phone (414) 855-2914
Other names 1
- Dr. Bethany Anne Shutko
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10644-024 | WI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557446400000",
"number": "1326060419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3301 W FOREST HOME AVE",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532152843",
"telephone_number": "414-389-2338",
"fax_number": "414-385-8987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8901 W LINCOLN AVE STE 405",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "53227",
"telephone_number": "414-329-5658"
}
],
"practiceLocations": [
{
"address_1": "2500 W. Layton Ave",
"address_2": "Ste 160",
"address_purpose": "LOCATION",
"city": "Milwaukee",
"state": "WI",
"postal_code": "53221",
"country_code": "US",
"telephone_number": "414-389-3023",
"fax_number": "414-817-5745",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4202 W Oakwood Park Ct Ste 310",
"address_purpose": "LOCATION",
"city": "Franklin",
"state": "WI",
"postal_code": "53132",
"country_code": "US",
"telephone_number": "414-855-2914",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TABIEROS",
"first_name": "BETHANY",
"middle_name": "ANNE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2019-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WI",
"license": "10644-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BETHANY",
"last_name": "SHUTKO",
"middle_name": "ANNE",
"prefix": "DR.",
"credential": "DPT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.