Provider Demographics
NPI:1073601845
Name:ANDERSON, BETH CLAIRE (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:CLAIRE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CLAIRE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6201 AUTUMNWOOD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7303
Mailing Address - Country:US
Mailing Address - Phone:214-277-4479
Mailing Address - Fax:
Practice Address - Street 1:2611 INTERNET BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-9085
Practice Address - Country:US
Practice Address - Phone:972-377-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1050953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158625701Medicaid