Provider Demographics
NPI:1518951730
Name:BEARD, ELIZABETH RENEE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RENEE
Last Name:BEARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 FAIRMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2135
Mailing Address - Country:US
Mailing Address - Phone:304-363-0050
Mailing Address - Fax:304-363-0048
Practice Address - Street 1:200 FORT PIERPONT DR STE 107
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1327
Practice Address - Country:US
Practice Address - Phone:304-322-4232
Practice Address - Fax:043-224-2353
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9335681OtherGROUP
WV0157726000Medicaid
WV001716788OtherBC/BS
WV001200OtherLICENSE