Provider Demographics
NPI:1720176043
Name:BETH I.GUTHRIE
Entity Type:Organization
Organization Name:BETH I.GUTHRIE
Other - Org Name:BURKE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-387-5729
Mailing Address - Street 1:1859 TRUMANSBURG RD.
Mailing Address - Street 2:PO BOX 122
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14854-0122
Mailing Address - Country:US
Mailing Address - Phone:607-387-5729
Mailing Address - Fax:607-387-5315
Practice Address - Street 1:1859 TRUMANSBURG RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:14854
Practice Address - Country:US
Practice Address - Phone:607-387-5729
Practice Address - Fax:607-387-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02580385Medicaid
NY000149089OtherEXCELLUS BCBS
NY921585001OtherHEALTHNOW NEW YORK
NY921585001OtherHEALTHNOW NEW YORK