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General NPI Number Information
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NPI Number | 1518044023
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Entity Type | Individual
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Provider Name | KURT EUGENE BEACH ATC
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2865 N REYNOLDS RD STE 110
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City | TOLEDO
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State | OH
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Zip | 43615-2069
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Country | US
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Telephone | 419-578-7530
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Fax | 419-539-0288
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Provider Business Mailing Address
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Address Line | 224 W 7TH ST
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City | PERRYSBURG
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State | OH
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Zip | 43551-1555
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Country | US
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Telephone | 419-873-1935
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 002253
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License Number State | OH
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