Provider Demographics
NPI:1407035736
Name:RUBERTO-BEACHLER, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RUBERTO-BEACHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 JASMINE DR.
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853
Mailing Address - Country:US
Mailing Address - Phone:301-929-9231
Mailing Address - Fax:301-929-9231
Practice Address - Street 1:4701 JASMINE DR.
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853
Practice Address - Country:US
Practice Address - Phone:301-929-9231
Practice Address - Fax:301-929-9231
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16409133N00000X
MD17977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist