Provider Demographics
NPI:1386987816
Name:BORECKY, BETH A (LMT, BCTMB,MMMT,CPT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BORECKY
Suffix:
Gender:F
Credentials:LMT, BCTMB,MMMT,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 KELL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-2405
Mailing Address - Country:US
Mailing Address - Phone:814-474-5628
Mailing Address - Fax:
Practice Address - Street 1:5040 W RIDGE RD SUITE 208
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1271
Practice Address - Country:US
Practice Address - Phone:814-873-6324
Practice Address - Fax:814-446-7837
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG006157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist