Provider Demographics
NPI:1568632602
Name:LEVEN, BETH GOLDMAN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:GOLDMAN
Last Name:LEVEN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:FRANCES
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:15 GRAY BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1101
Mailing Address - Country:US
Mailing Address - Phone:508-358-6669
Mailing Address - Fax:
Practice Address - Street 1:15 GRAY BIRCH LN
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1101
Practice Address - Country:US
Practice Address - Phone:508-981-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT4670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66290Medicare UPIN