Healthcare Provider Details

I. General information

NPI: 1508922469
Provider Name (Legal Business Name): TIMOTHY P BEAGAN PTA,AT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MAIN ST
NORWAY ME
04268-5925
US

IV. Provider business mailing address

374 MAIN ST
NORWAY ME
04268-5925
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-5493
  • Fax: 207-743-5563
Mailing address:
  • Phone: 207-743-5493
  • Fax: 207-743-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPA74000858
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT270
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: