Provider Demographics
NPI:1508987942
Name:BORCHELT, BETH ANNELLE (MS,PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANNELLE
Last Name:BORCHELT
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MAPLE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1838
Mailing Address - Country:US
Mailing Address - Phone:508-835-9241
Mailing Address - Fax:
Practice Address - Street 1:9 MAPLE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1838
Practice Address - Country:US
Practice Address - Phone:508-835-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAH6706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAIS G SF90OtherHARVARD PILGRIM