Provider Demographics
NPI:1740206671
Name:BEARD, DONNETTE N (LMT)
Entity Type:Individual
Prefix:
First Name:DONNETTE
Middle Name:N
Last Name:BEARD
Suffix:
Gender:F
Credentials:LMT
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 306
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:FL
Mailing Address - Zip Code:32160-0306
Mailing Address - Country:US
Mailing Address - Phone:352-473-6053
Mailing Address - Fax:352-473-6053
Practice Address - Street 1:7426 STATE ROAD 21
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656
Practice Address - Country:US
Practice Address - Phone:253-473-6053
Practice Address - Fax:352-473-6053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC6783OtherBCBS