MEDICARE: KELLY CHRISTINE BEASLEY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	012550	OH

General Provider Information

NPI Number	:	1073821997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY CHRISTINE BEASLEY DPT

Provider Business Mailing Address
First Line	:	15 COLD SPRINGS CT
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9421
Country	:	US
Telephone Number	:	937-361-5297
Fax Number	:

Provider Business Practice Location Address
First Line	:	3060 DAYTON XENIA RD STE C
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45434-6393
Country	:	US
Telephone Number	:	937-427-2225
Fax Number	:	937-405-1078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	10/17/2022

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