MEDICARE: DR. ALEXANDRIA BEAUDOIN 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	6238	NV

General Provider Information

NPI Number	:	1093587115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRIA BEAUDOIN DPT

Provider Business Mailing Address
First Line	:	5785 CENTENNIAL CENTER BLVD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-7111
Country	:	US
Telephone Number	:	702-916-2777
Fax Number	:	702-916-2778

Provider Business Practice Location Address
First Line	:	5785 CENTENNIAL CENTER BLVD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-7111
Country	:	US
Telephone Number	:	702-916-2777
Fax Number	:	702-916-2778

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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