Healthcare Provider Details

I. General information

NPI: 1689507071
Provider Name (Legal Business Name): SARAH NICOLE BEAUPRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W SQUARE LAKE RD
TROY MI
48098-2929
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 246-688-9010
  • Fax: 248-688-9013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502009045
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: