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General NPI Number Information
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NPI Number | 1942164884
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Entity Type | Individual
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Provider Name | BETH ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 252 WESTBROOK RD
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City | ESSEX
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State | CT
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Zip | 06426-1513
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Country | US
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Telephone | 860-358-3975
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Fax | 860-358-2727
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Provider Business Mailing Address
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Address Line | 95 FALLS RD
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City | MOODUS
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State | CT
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Zip | 06469-1211
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Country | US
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Telephone | 860-358-3975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 003803
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License Number State | CT
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