Provider Demographics
NPI:1225156490
Name:BEAULIEU, DEBORAH TWING (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:TWING
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 POND RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-2221
Mailing Address - Country:US
Mailing Address - Phone:207-783-3682
Mailing Address - Fax:
Practice Address - Street 1:102 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6019
Practice Address - Country:US
Practice Address - Phone:207-777-4219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist