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NPI Code Detail

MEDICARE: MR. KURT EUGENE BEACH ATC

MEDICARE: MR. KURT EUGENE BEACH ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic Trainer002253OH

General Provider Information

NPI Number : 1518044023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KURT EUGENE BEACH ATC
Provider Business Mailing Address
First Line : 224 W 7TH ST
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-1555
Country : US
Telephone Number : 419-873-1935
Fax Number :
Provider Business Practice Location Address
First Line : 2865 N REYNOLDS RD STE 110
Second Line :
City : TOLEDO
State : OH
Zip : 43615-2069
Country : US
Telephone Number : 419-578-7530
Fax Number : 419-539-0288
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ MR. KURT EUGENE BEACH ATC” Practice Location

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