Healthcare Provider Details

I. General information

NPI: 1003802992
Provider Name (Legal Business Name): BETH A CARR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 WATER ST
NORTHUMBERLAND PA
17857-1243
US

IV. Provider business mailing address

PO BOX 64
NORTHUMBERLAND PA
17857-0064
US

V. Phone/Fax

Practice location:
  • Phone: 570-473-3912
  • Fax: 570-473-8731
Mailing address:
  • Phone: 570-473-3912
  • Fax: 570-473-8731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00373IL
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: