Provider Demographics
NPI:1558320549
Name:CASOLA, BETH G (PT MA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:G
Last Name:CASOLA
Suffix:
Gender:F
Credentials:PT MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14B ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2552
Mailing Address - Country:US
Mailing Address - Phone:973-635-6535
Mailing Address - Fax:973-635-4099
Practice Address - Street 1:14B ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2552
Practice Address - Country:US
Practice Address - Phone:973-635-6535
Practice Address - Fax:973-635-4099
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00493800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ681443DJBMedicare ID - Type Unspecified