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NPI Code Detail

MEDICARE: DAMIEN JOSEPH BEARD PT

MEDICARE: DAMIEN JOSEPH BEARD PT
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
1225100000XPhysical Therapist05006697AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000092828OTHERINANTHEM

General Provider Information

NPI Number : 1235179169
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMIEN JOSEPH BEARD PT
Provider Business Mailing Address
First Line : 7759 E WASHINGTON ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-6742
Country : US
Telephone Number : 317-359-1215
Fax Number : 317-359-1235
Provider Business Practice Location Address
First Line : 321 E NORTHFIELD DR
Second Line : #200
City : BROWNSBURG
State : IN
Zip : 46112-2415
Country : US
Telephone Number : 317-852-1771
Fax Number : 317-852-1782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 07/08/2007

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