MEDICARE: MARY BETH NEWSOME PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305214493	VA
2	225100000X	Physical Therapist		GA
3	225100000X	Physical Therapist	P19473	NC

General Provider Information

NPI Number	:	1396090122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH NEWSOME PT

Provider Business Mailing Address
First Line	:	860 OMNI BLVD STE 103
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-4430
Country	:	US
Telephone Number	:	757-223-9403
Fax Number	:	757-223-5546

Provider Business Practice Location Address
First Line	:	1481 KELLY RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-9572
Country	:	US
Telephone Number	:	919-296-8180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2012
Last Update Date	:	07/17/2024

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Directions to “ MARY BETH NEWSOME PT” Practice Location

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