Provider Demographics
NPI:1659317451
Name:BEAUCHESNE, LAURA H (DPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:H
Last Name:BEAUCHESNE
Suffix:
Gender:F
Credentials:DPT
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 15
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-0015
Mailing Address - Country:US
Mailing Address - Phone:207-324-3745
Mailing Address - Fax:
Practice Address - Street 1:15 DAIGLE LN STE 101
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-4173
Practice Address - Country:US
Practice Address - Phone:207-324-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME041334OtherANTHEM
ME041334OtherANTHEM