Provider Demographics
NPI:1659593846
Name:MARCOUX, BETH (PHD, DPT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MARCOUX
Suffix:
Gender:F
Credentials:PHD, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 OLD KEEWAYDIN POINT RD
Mailing Address - Street 2:P.O. BOX 1714
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894
Mailing Address - Country:US
Mailing Address - Phone:860-235-8742
Mailing Address - Fax:
Practice Address - Street 1:104 OLD KEEWAYDIN POINT RD
Practice Address - Street 2:SUITE BOX 1714
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894
Practice Address - Country:US
Practice Address - Phone:860-235-8742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7554-9Medicare UPIN
RI64-00196Medicare UPIN