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General NPI Number Information
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NPI Number | 1144848540
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Entity Type | Individual
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Provider Name | ALEXA P BEAUMONT ATC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2020
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 3300 POINSETT HWY
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City | GREENVILLE
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State | SC
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Zip | 29613-1864
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Country | US
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Telephone | 908-343-9231
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Fax |
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Provider Business Mailing Address
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Address Line | 34 HARVEST BELL LN
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City | TAYLORS
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State | SC
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Zip | 29687-3575
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Country | US
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Telephone | 908-343-9231
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT03299
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License Number State | SC
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