Healthcare Provider Details

I. General information

NPI: 1619106424
Provider Name (Legal Business Name): LAUREN M. B. BEARD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 ANDERSON HWY SUITE 2
POWHATAN VA
23139-5846
US

IV. Provider business mailing address

2324 BATH ST
SANTA BARBARA CA
93105-4330
US

V. Phone/Fax

Practice location:
  • Phone: 804-598-2100
  • Fax: 804-598-7624
Mailing address:
  • Phone: 805-682-3870
  • Fax: 805-569-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: