Healthcare Provider Details

I. General information

NPI: 1518095835
Provider Name (Legal Business Name): AMY L BEACHAM P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 EAST NAPLES ST
CHULA VISTA CA
91911
US

IV. Provider business mailing address

4876 ACADEMY ST
SAN DIEGO CA
92109
US

V. Phone/Fax

Practice location:
  • Phone: 619-421-6083
  • Fax: 619-482-8284
Mailing address:
  • Phone: 619-421-6083
  • Fax: 619-482-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT17560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: