Provider Demographics
NPI:1295739761
Name:BEARD, ERIC A (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:A
Last Name:BEARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1141
Mailing Address - Country:US
Mailing Address - Phone:304-329-3908
Mailing Address - Fax:304-329-3918
Practice Address - Street 1:1900 LOCUST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1239
Practice Address - Country:US
Practice Address - Phone:304-225-5222
Practice Address - Fax:304-333-5224
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7304088-000Medicaid
WV9335682OtherGROUP
WV5578154OtherCIGNA
WV550763083002OtherBC/BS
WV9335681OtherGROUP
WV9335684OtherGROUP
WV245634OtherCARELINK
WV7157346OtherAETNA
WV9335684OtherGROUP
WV550763083002OtherBC/BS
WV7304088-000Medicaid