Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 15397 | MD |
N | 2251H1200X | Hand | 15397 | MD |
NPI | 1073581534 |
---|---|
Provider Name | Mrs. Regina Ann Beatus |
First Address | Salisbury, MD 21804-6921 |
Second Address | Salisbury, MD 21804-6921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 25/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
JO37 | BCBS (01) | MD |
R7570001 | BLUE CHOICE (01) | MD |