Doctor Name: | MICHAEL A BEARDSLEY |
NPI Number: | 1427279736 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | |
Business Practice Address: | 1206 Sw Main Blvd Suite 101 Lake City, FL - 320256684 |
Business Phone Number: | 3867521652 |
Business Fax Number: | 3867520939 |
Mailing Address: | 204 Nw Emporia Gln, LAKE CITY |
State: | FL |
Postal Code: | 320558516 |
Phone Number: | 3867520749 |
Fax Number: | |
NPI Enumeration Date: | 05/02/2007 |
NPI Last Update Date: | 10/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |