Provider Demographics
NPI:1407194244
Name:BEACH, TIMOTHY GARRICK (RRT-NPS)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GARRICK
Last Name:BEACH
Suffix:
Gender:M
Credentials:RRT-NPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22007 DIAMOND CHASE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2744
Mailing Address - Country:US
Mailing Address - Phone:210-473-8896
Mailing Address - Fax:
Practice Address - Street 1:22007 DIAMOND CHASE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2744
Practice Address - Country:US
Practice Address - Phone:210-473-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647402279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics