Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1146433 | TX |
NPI | 1114344355 |
---|---|
Provider Name | Kevin Beaugh |
First Address | Lubbock, TX 79414-4875 |
Second Address | Lubbock, TX 79414-4875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 26/03/2014 |