Provider Demographics
NPI:1063783090
Name:BELTZ, ELEANOR MANSON (MS, ATC, CSCS, CES)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:MANSON
Last Name:BELTZ
Suffix:
Gender:F
Credentials:MS, ATC, CSCS, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SAINT ANSELM DR
Mailing Address - Street 2:#1727
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-1308
Mailing Address - Country:US
Mailing Address - Phone:603-222-4081
Mailing Address - Fax:603-222-4091
Practice Address - Street 1:100 SAINT ANSELM DR
Practice Address - Street 2:#1727
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-1308
Practice Address - Country:US
Practice Address - Phone:603-222-4081
Practice Address - Fax:603-222-4091
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04612255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer