Provider Demographics
NPI:1720323199
Name:ELLIOTT, BETH ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:ELLEN
Other - Last Name:VENTRESCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:29614 W OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1844
Mailing Address - Country:US
Mailing Address - Phone:440-871-6529
Mailing Address - Fax:440-871-6529
Practice Address - Street 1:6500 ROCKSIDE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2368
Practice Address - Country:US
Practice Address - Phone:877-907-0400
Practice Address - Fax:877-901-0401
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist