Provider Demographics
NPI:1578508131
Name:BEASLEY, NANCY J (ATC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:J
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 E 40 S
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47949-8080
Mailing Address - Country:US
Mailing Address - Phone:765-366-6606
Mailing Address - Fax:
Practice Address - Street 1:3332 E 40 S
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47949-8080
Practice Address - Country:US
Practice Address - Phone:765-366-6606
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000212A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer