Provider Demographics
NPI:1710025002
Name:BEAUMONT, REBECCA JEAN (LPTA)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
Last Name:BEAUMONT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9225
Mailing Address - Country:US
Mailing Address - Phone:501-672-1170
Mailing Address - Fax:
Practice Address - Street 1:207 FRED RAINS DR
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-5457
Practice Address - Country:US
Practice Address - Phone:501-834-0217
Practice Address - Fax:501-833-0957
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA1678225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139236721Medicaid