Healthcare Provider Details

I. General information

NPI: 1760688097
Provider Name (Legal Business Name): STEPHANIE LAINE BEAUREGARD P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2007
Last Update Date: 06/11/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FT. BELVOIR VA
22060-3231
US

IV. Provider business mailing address

9300 DEWITT LOOP INTREPID SPIRIT CENTER, BLDG. 1259
FORT BELVOIR VA
22060
US

V. Phone/Fax

Practice location:
  • Phone: 703-806-4244
  • Fax:
Mailing address:
  • Phone: 571-231-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305204251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: