Provider Demographics
NPI:1962036897
Name:BEARD, MACHELL H (PTA)
Entity Type:Individual
Prefix:
First Name:MACHELL
Middle Name:H
Last Name:BEARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FIG ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080-1761
Mailing Address - Country:US
Mailing Address - Phone:573-259-1404
Mailing Address - Fax:
Practice Address - Street 1:311 N SPRING ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-5089
Practice Address - Country:US
Practice Address - Phone:573-775-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117069225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant