Provider Demographics
NPI:1942752100
Name:BEAUSOLEIL, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BEAUSOLEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SW 17TH ST
Mailing Address - Street 2:BOX 209-229
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 SW 17TH ST
Practice Address - Street 2:BOX 209-229
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1231
Practice Address - Country:US
Practice Address - Phone:352-693-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-03
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist