Provider Demographics
NPI:1639459480
Name:BEAUCHAMP, CHAD STEPHEN (PT)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:STEPHEN
Last Name:BEAUCHAMP
Suffix:
Gender:M
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:PO BOX 1122
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-1122
Mailing Address - Country:US
Mailing Address - Phone:714-377-4314
Mailing Address - Fax:714-377-4311
Practice Address - Street 1:7146 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3568
Practice Address - Country:US
Practice Address - Phone:714-377-4314
Practice Address - Fax:714-377-4311
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38002225100000X
OH0134002251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports