Healthcare Provider Details

I. General information

NPI: 1750456422
Provider Name (Legal Business Name): LYNNE BEAUMONT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNNE BEAUMONT PT

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 DATE PALM DR
LAKE PARK FL
33403-3571
US

IV. Provider business mailing address

131 DATE PALM DR
LAKE PARK FL
33403-3571
US

V. Phone/Fax

Practice location:
  • Phone: 561-512-5755
  • Fax: 561-863-4220
Mailing address:
  • Phone: 561-512-5755
  • Fax: 561-863-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: