Provider Demographics
NPI:1518044023
Name:BEACH, KURT EUGENE (ATC)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:EUGENE
Last Name:BEACH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1555
Mailing Address - Country:US
Mailing Address - Phone:419-873-1935
Mailing Address - Fax:
Practice Address - Street 1:2865 N REYNOLDS RD STE 110
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2069
Practice Address - Country:US
Practice Address - Phone:419-578-7530
Practice Address - Fax:419-539-0288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0022532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer