Provider Demographics
NPI:1295021467
Name:BELTRAN, ALBERTO D (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:D
Last Name:BELTRAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4834
Mailing Address - Country:US
Mailing Address - Phone:978-457-6528
Mailing Address - Fax:
Practice Address - Street 1:10 CENTENNIAL DR STE J
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7900
Practice Address - Country:US
Practice Address - Phone:978-826-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA907225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist