Healthcare Provider Details

I. General information

NPI: 1639459480
Provider Name (Legal Business Name): CHAD STEPHEN BEAUCHAMP PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7146 EDINGER AVE
HUNTINGTON BEACH CA
92647-3568
US

IV. Provider business mailing address

PO BOX 1122
RHINELANDER WI
54501-1122
US

V. Phone/Fax

Practice location:
  • Phone: 714-377-4314
  • Fax: 714-377-4311
Mailing address:
  • Phone: 714-377-4314
  • Fax: 714-377-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38002
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number013400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: