Provider Demographics
NPI:1053400051
Name:BEAULIEU, LINDA M (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BEAULIEU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01062-3528
Mailing Address - Country:US
Mailing Address - Phone:413-582-0005
Mailing Address - Fax:413-582-7979
Practice Address - Street 1:17 NEW SOUTH ST - SULLIVAN SQ
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-582-0005
Practice Address - Fax:413-582-7979
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0387126Medicaid
MAY65760OtherBC/BS
MAY68343Medicare ID - Type Unspecified