Provider Demographics
NPI:1841281284
Name:BEA, JOYCE LAWTON (RPT)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:LAWTON
Last Name:BEA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 HIGHLAND AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3454
Mailing Address - Country:US
Mailing Address - Phone:203-573-9806
Mailing Address - Fax:203-573-9806
Practice Address - Street 1:417 HIGHLAND AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3454
Practice Address - Country:US
Practice Address - Phone:203-573-9806
Practice Address - Fax:203-573-9806
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6404274OtherUNITED HEALTHCARE
OV1720OtherHEALTH NET
ANC733OtherOXFORD
080001428CT02OtherBCBS
0506722OtherUS HEALTHCARE
CTC02971Medicare ID - Type Unspecified