Provider Demographics
NPI:1376618009
Name:FASANO, BETH (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:FASANO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1824
Mailing Address - Country:US
Mailing Address - Phone:978-887-6498
Mailing Address - Fax:
Practice Address - Street 1:125 IPSWICH RD
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1549
Practice Address - Country:US
Practice Address - Phone:978-887-0008
Practice Address - Fax:978-887-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA926111N00000X
MA3821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66806Medicare ID - Type Unspecified