Provider Demographics
NPI:1568426989
Name:BEAULIEU, BRIAN L (PT, MPT, OCS,CMTPT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:L
Last Name:BEAULIEU
Suffix:
Gender:M
Credentials:PT, MPT, OCS,CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:2004 SANDBRIDGE RD STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4084
Practice Address - Country:US
Practice Address - Phone:757-301-6419
Practice Address - Fax:757-301-6419
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00140444OtherRAILROAD MEDICARE
VA010097215Medicaid
VA192967OtherBCBS PHYSICAL THERAPY
7445089OtherAETNA
VAP00140444OtherRAILROAD MEDICARE
VA192967OtherBCBS PHYSICAL THERAPY