Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 013778-1 | NY |
NPI | 1144869926 |
---|---|
Provider Name | Ms. Debbie Jane Beauregard |
First Address | Rochester, NY 14626-4122 |
Second Address | Rochester, NY 14626-4122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2019 |
Last Update Date | 27/12/2019 |