Provider Demographics
NPI:1487701967
Name:BEAUMONT, BETH A (PT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BEAUMONT
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 1:925 N. LEGRANGE ROAD
Mailing Address - Street 2:APT#2
Mailing Address - City:LEGRANGE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60526
Mailing Address - Country:US
Mailing Address - Phone:312-225-3119
Mailing Address - Fax:312-225-3219
Practice Address - Street 1:654 W VETERANS PARKWAY
Practice Address - Street 2:STE D
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-2510
Practice Address - Country:US
Practice Address - Phone:630-553-9300
Practice Address - Fax:630-553-9306
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist