Provider Demographics
NPI:1518990548
Name:BEACHLER PEDIATRIC PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:BEACHLER PEDIATRIC PHYSICAL THERAPY, INC.
Other - Org Name:AUDREY BEACHLER PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:GUNTER
Authorized Official - Last Name:BEACHLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:919-708-5131
Mailing Address - Street 1:115 PETTY RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7290
Mailing Address - Country:US
Mailing Address - Phone:919-708-5131
Mailing Address - Fax:
Practice Address - Street 1:115 PETTY RD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7290
Practice Address - Country:US
Practice Address - Phone:919-708-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079FWOtherBLUE CROSS/BLUE SHIELD
NC720795PMedicaid