Provider Demographics
NPI:1467654517
Name:BEYER, AUTUMN LORRAINE (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:LORRAINE
Last Name:BEYER
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:HAMADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:320 MAIN ST
Practice Address - Street 2:2ND FL
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1601
Practice Address - Country:US
Practice Address - Phone:814-534-1095
Practice Address - Fax:814-534-6145
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0040682255A2300X
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer