Provider Demographics
NPI:1295041457
Name:WHITEHEAD, BETH ANNE
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 STROUDWATER ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4045
Mailing Address - Country:US
Mailing Address - Phone:207-854-0850
Mailing Address - Fax:207-854-0851
Practice Address - Street 1:117 STROUDWATER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4045
Practice Address - Country:US
Practice Address - Phone:207-854-0850
Practice Address - Fax:207-854-0851
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 2721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist