Basic Information
| Provider Information | |||||||||
| NPI: | 1467922781 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEACHFRONT THERAPY CONSULTANTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3120 SOUNDVIEW DR W | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984661612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532231829 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3120 SOUNDVIEW DR W | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984661612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532231829 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2018 | ||||||||
| LastUpdateDate: | 11/29/2018 | ||||||||
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| AuthorizedOfficialLastName: | GARLOCK | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2532231829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, LMT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.