Provider Demographics
NPI:1083381867
Name:BEAUDET, DEENA RAE (DPT)
Entity Type:Individual
Prefix:DR
First Name:DEENA
Middle Name:RAE
Last Name:BEAUDET
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1207
Mailing Address - Country:US
Mailing Address - Phone:585-261-0150
Mailing Address - Fax:
Practice Address - Street 1:11 2ND ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1207
Practice Address - Country:US
Practice Address - Phone:585-261-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8830225100000X
NY008830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist