Provider Demographics
NPI:1073912341
Name:BETH MARCOUX LLC
Entity Type:Organization
Organization Name:BETH MARCOUX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARCOUX
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PHD
Authorized Official - Phone:603-452-4263
Mailing Address - Street 1:P.O. BOX 1714
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894
Mailing Address - Country:US
Mailing Address - Phone:603-452-4263
Mailing Address - Fax:
Practice Address - Street 1:42 CAMPFIRE CIRCLE
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809
Practice Address - Country:US
Practice Address - Phone:603-452-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty