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General NPI Number Information
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NPI Number | 1679342919
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Entity Type | Individual
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Provider Name | MATTHEW J BEAUREGARD ATC
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Gender | Male
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 3031 GARRISON RD
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City | DUNEDIN
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State | FL
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Zip | 34698-9212
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Country | US
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Telephone | 727-733-0429
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Fax |
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Provider Business Mailing Address
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Address Line | 5931 N 125TH AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-3815
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Country | US
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Telephone | 216-633-2183
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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 | AT003591
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License Number State | OH
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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 | 1018
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License Number State | AZ
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