| Doctor Name: | BETH W. MANTIS |
| NPI Number: | 1992056857 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMT |
| License Number: | 18018 |
| Business Practice Address: | 29544 Se Heiple Rd Eagle Creek, OR - 970229664 |
| Business Phone Number: | 5038876070 |
| Business Fax Number: | 5036302860 |
| Mailing Address: | 29544 Se Heiple Rd, EAGLE CREEK |
| State: | OR |
| Postal Code: | 970229664 |
| Phone Number: | 5038876070 |
| Fax Number: | 5036302860 |
| NPI Enumeration Date: | 10/01/2012 |
| NPI Last Update Date: | 10/01/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225400000X |
| License Number: | 18018 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Rehabilitation Practitioner |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. |