Healthcare Provider Details

I. General information

NPI: 1568659357
Provider Name (Legal Business Name): CRISTIN CONWAY BEAZLEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTIN MARIE CONWAY PT

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

8254 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

V. Phone/Fax

Practice location:
  • Phone: 804-764-7021
  • Fax:
Mailing address:
  • Phone: 804-764-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: