Provider Demographics
NPI:1073712972
Name:BEAUCHESNE, NOEL GEORGETTE (PTA)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:GEORGETTE
Last Name:BEAUCHESNE
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 1:17185 72ND RD N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3072
Mailing Address - Country:US
Mailing Address - Phone:561-723-5450
Mailing Address - Fax:
Practice Address - Street 1:17185 72ND RD N
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3072
Practice Address - Country:US
Practice Address - Phone:561-723-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19611225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46-1737897OtherEIN