Provider Demographics
NPI:1508922469
Name:BEAGAN, TIMOTHY P (PTA,AT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:BEAGAN
Suffix:
Gender:M
Credentials:PTA,AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5925
Mailing Address - Country:US
Mailing Address - Phone:207-743-5493
Mailing Address - Fax:207-743-5563
Practice Address - Street 1:374 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5925
Practice Address - Country:US
Practice Address - Phone:207-743-5493
Practice Address - Fax:207-743-5563
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2702255A2300X
MEPA74000858225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer