Provider Demographics
NPI:1609152859
Name:TRIMARK-CONNOR, BETH A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:TRIMARK-CONNOR
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 1:20 DILLINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2786
Mailing Address - Country:US
Mailing Address - Phone:336-543-8082
Mailing Address - Fax:
Practice Address - Street 1:20 DILLINGHAM PL
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2786
Practice Address - Country:US
Practice Address - Phone:336-543-8082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist