Provider Demographics
NPI:1619106424
Name:BEARD, LAUREN M B (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:M B
Last Name:BEARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 BATH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4330
Mailing Address - Country:US
Mailing Address - Phone:805-682-3870
Mailing Address - Fax:805-569-3860
Practice Address - Street 1:3510 ANDERSON HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-5846
Practice Address - Country:US
Practice Address - Phone:804-598-2100
Practice Address - Fax:804-598-7624
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05954OtherMEDICARE GROUP PTAN
VA1619106424OtherMEDICAID QMB PROVIDER ID
VAP01455929OtherMEDICARE RAILROAD PTAN
VA1619106424OtherMEDICAID QMB PROVIDER ID