Provider Demographics
NPI:1568156040
Name:LINK-RICHARDSON, BETH M
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:LINK-RICHARDSON
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 1:135 KETTLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-1853
Mailing Address - Country:US
Mailing Address - Phone:908-834-7494
Mailing Address - Fax:
Practice Address - Street 1:135 KETTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-1853
Practice Address - Country:US
Practice Address - Phone:908-834-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA007473225100000X
225100000X
NJ40QA007473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist