Provider Demographics
NPI:1710222922
Name:AMENTA, BEATRICE SANDRA
Entity Type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:SANDRA
Last Name:AMENTA
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 1:5 ORCHARD HILL DR
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2419
Mailing Address - Country:US
Mailing Address - Phone:860-436-3696
Mailing Address - Fax:
Practice Address - Street 1:5 ORCHARD HILL DR
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-2419
Practice Address - Country:US
Practice Address - Phone:860-436-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist