Provider Demographics
NPI:1740487917
Name:BEELER, LAUREN (PT, PCS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BEELER
Suffix:
Gender:F
Credentials:PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28715 VISTA SANTIAGO ROAD
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1105
Mailing Address - Country:US
Mailing Address - Phone:949-589-1405
Mailing Address - Fax:949-709-3360
Practice Address - Street 1:28715 VISTA SANTIAGO RD
Practice Address - Street 2:
Practice Address - City:TRABUCO CANYON
Practice Address - State:CA
Practice Address - Zip Code:92679-1105
Practice Address - Country:US
Practice Address - Phone:949-589-1405
Practice Address - Fax:949-709-3360
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA#PT117592251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics