Provider Demographics
NPI:1326138793
Name:BEACH, BARBARA ANN (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:BEACH
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 1:2207 CONCORD AVE NW
Mailing Address - Street 2:SUITE #100
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112
Mailing Address - Country:US
Mailing Address - Phone:812-738-3616
Mailing Address - Fax:812-738-3619
Practice Address - Street 1:2207 CONCORD AVE NW
Practice Address - Street 2:SUITE #100
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112
Practice Address - Country:US
Practice Address - Phone:812-738-3616
Practice Address - Fax:812-738-3619
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05002502A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN05002502AOtherPT LIC#