Provider Demographics
NPI:1184662827
Name:BETZ, CAROLINE SPENCER (PT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:SPENCER
Last Name:BETZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12717 STONEBRIAR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7052
Mailing Address - Country:US
Mailing Address - Phone:804-358-3687
Mailing Address - Fax:804-378-8870
Practice Address - Street 1:1300 ALVERSER PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2604
Practice Address - Country:US
Practice Address - Phone:804-378-9968
Practice Address - Fax:804-378-8870
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA154452OtherANTHEM BCBS
VA005975C92Medicare ID - Type Unspecified