Provider Demographics
NPI:1306873310
Name:BEACH, JOSEPH STEVEN (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:STEVEN
Last Name:BEACH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 942
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30752-0942
Mailing Address - Country:US
Mailing Address - Phone:706-657-2700
Mailing Address - Fax:706-657-7965
Practice Address - Street 1:12138 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:GA
Practice Address - Zip Code:30752-5151
Practice Address - Country:US
Practice Address - Phone:706-657-2700
Practice Address - Fax:706-657-7965
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000000881225200000X
GAPTA000430225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5100496100OtherBCBS OF GEORGIA
GA6109965001OtherCIGNA OF GEORGIA
TN3110918OtherBCBS OF TENNESSEE
TN4978909OtherCIGNA OF TENNESSEE
GA116565Medicare ID - Type UnspecifiedGEORGIA MEDICARE
GA5100496100OtherBCBS OF GEORGIA