Basic Information
| Provider Information | |||||||||
| NPI: | 1619106424 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEARD | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | M. B. | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2324 BATH ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931054330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056823870 | ||||||||
| FaxNumber: | 8055693860 | ||||||||
| Practice Location | |||||||||
| Address1: | 3510 ANDERSON HWY | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | POWHATAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231395846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045982100 | ||||||||
| FaxNumber: | 8045987624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2009 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305206029 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | C05954 | 01 | VA | MEDICARE GROUP PTAN | OTHER | 1619106424 | 01 | VA | MEDICAID QMB PROVIDER ID | OTHER | P01455929 | 01 | VA | MEDICARE RAILROAD PTAN | OTHER |