Provider Demographics
NPI:1285618488
Name:FLANNERY SPILLANE, BETH ANN (PT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:FLANNERY SPILLANE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:FLANNERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:113 LABBY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-1247
Mailing Address - Country:US
Mailing Address - Phone:860-497-0239
Mailing Address - Fax:860-497-0047
Practice Address - Street 1:113 LABBY RD
Practice Address - Street 2:
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-1247
Practice Address - Country:US
Practice Address - Phone:860-497-0239
Practice Address - Fax:860-497-0047
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0325660Medicaid
MA0325660Medicaid