Provider Demographics
NPI:1639321623
Name:WAUGH, BETH S (MS, PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:S
Last Name:WAUGH
Suffix:
Gender:F
Credentials:MS, PT
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Other - Last Name:
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Mailing Address - Street 1:114 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1408
Mailing Address - Country:US
Mailing Address - Phone:518-409-0544
Mailing Address - Fax:518-233-0703
Practice Address - Street 1:597 3RD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2509
Practice Address - Country:US
Practice Address - Phone:518-233-0935
Practice Address - Fax:518-233-0703
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY014678-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics