Provider Demographics
NPI:1467534875
Name:BEACH, MICHELE A (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:A
Last Name:BEACH
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:DIFONZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:1351 MCFARLAND BLVD NE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2265
Mailing Address - Country:US
Mailing Address - Phone:205-344-4443
Mailing Address - Fax:205-344-4055
Practice Address - Street 1:1351 MCFARLAND BLVD NE
Practice Address - Street 2:SUITE 104
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2265
Practice Address - Country:US
Practice Address - Phone:205-344-4443
Practice Address - Fax:205-344-4055
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51521175OtherBLUE CROSS BLUE SHIELD
ALS77903Medicare UPIN