Provider Demographics
NPI:1346585213
Name:MARTIN, BETH ELLEN (RPT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19A DUNCAN DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373-9771
Mailing Address - Country:US
Mailing Address - Phone:413-772-9937
Mailing Address - Fax:
Practice Address - Street 1:19A DUNCAN DR
Practice Address - Street 2:
Practice Address - City:SOUTH DEERFIELD
Practice Address - State:MA
Practice Address - Zip Code:01373-9771
Practice Address - Country:US
Practice Address - Phone:413-772-9937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist