Provider Demographics
NPI:1942246699
Name:SWANSON, BETH W (PT, MS, OCS)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:W
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-0732
Mailing Address - Country:US
Mailing Address - Phone:603-526-2781
Mailing Address - Fax:603-526-2618
Practice Address - Street 1:75 NEWPORT RD
Practice Address - Street 2:SUITE NUMBER 3
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5467
Practice Address - Country:US
Practice Address - Phone:603-526-2781
Practice Address - Fax:603-526-2618
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30393928Medicaid
NH0802932Y0NH01OtherANTHEM BCBS OF NH
NH30393928Medicaid