Provider Demographics
NPI:1679619951
Name:MAYBEN, BETTY LEE (PTA)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:LEE
Last Name:MAYBEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 DW HIGHWAY
Mailing Address - Street 2:SOUTHERN NEW HAMPSHIRE REHABILITATION CENTER
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054
Mailing Address - Country:US
Mailing Address - Phone:603-429-8427
Mailing Address - Fax:603-429-1756
Practice Address - Street 1:399 DANIEL WEBSTER HWY
Practice Address - Street 2:SNHRC
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-4112
Practice Address - Country:US
Practice Address - Phone:603-429-8427
Practice Address - Fax:603-429-1756
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0075225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant