Provider Demographics
NPI:1932329679
Name:BEAUCHAMP, TYLER (LMT)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BEAUCHAMP
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 COACHMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121
Mailing Address - Country:US
Mailing Address - Phone:651-452-4220
Mailing Address - Fax:651-452-3829
Practice Address - Street 1:3390 COACHMAN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121
Practice Address - Country:US
Practice Address - Phone:651-452-4220
Practice Address - Fax:651-452-3829
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist