Provider Demographics
NPI:1043308679
Name:GUTHRIE, BETH INA (PT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:INA
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:GUTHRIE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1859 TRUMANSBURG ROAD
Mailing Address - Street 2:PO BOX 122
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14854-0122
Mailing Address - Country:US
Mailing Address - Phone:607-387-5729
Mailing Address - Fax:607-387-5315
Practice Address - Street 1:1859 TRUMANSBURG ROAD
Practice Address - Street 2:1859 TRUMANSBURG ROAD
Practice Address - City:JACKSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14854-0122
Practice Address - Country:US
Practice Address - Phone:607-387-5729
Practice Address - Fax:607-387-5315
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05422-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01041950Medicaid
NY7943023OtherAETNA
NY802479OtherACN GROUP
NY000915179001OtherHEALTHNOW NEW YORK
NYR57008Medicare UPIN
NY01041950Medicaid