Provider Demographics
NPI:1427279736
Name:BEARDSLEY, MICHAEL A (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BEARDSLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 NW EMPORIA GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8516
Mailing Address - Country:US
Mailing Address - Phone:386-752-0749
Mailing Address - Fax:
Practice Address - Street 1:1206 SW MAIN BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6684
Practice Address - Country:US
Practice Address - Phone:386-752-1652
Practice Address - Fax:386-752-0939
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty