Provider Demographics
NPI:1457860181
Name:BEARD, SEAN DAVID (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:DAVID
Last Name:BEARD
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 MORGANS LN SE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:IN
Mailing Address - Zip Code:47117-7809
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 WILLIAM THOMASON BYU
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-1419
Practice Address - Country:US
Practice Address - Phone:270-259-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist