Provider Demographics
NPI:1902872690
Name:PARIS, BETH (PT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:PARIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N CAYUGE ST
Mailing Address - Street 2:DEWITT BLDG
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-256-2603
Mailing Address - Fax:607-256-2603
Practice Address - Street 1:215 N CAYUGE ST
Practice Address - Street 2:DEWITT BLDG
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-256-2603
Practice Address - Fax:607-256-2603
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC4607Medicare ID - Type Unspecified