Healthcare Provider Details

I. General information

NPI: 1942164884
Provider Name (Legal Business Name): BETH ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 WESTBROOK RD
ESSEX CT
06426-1513
US

IV. Provider business mailing address

95 FALLS RD
MOODUS CT
06469-1211
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3975
  • Fax: 860-358-2727
Mailing address:
  • Phone: 860-358-3975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003803
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: