Basic Information
| Provider Information | |||||||||
| NPI: | 1831522341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUCHAMP | ||||||||
| FirstName: | BEAELISA | ||||||||
| MiddleName: | SUZETTE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8627 CINNAMON CREEK DR | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103720211 | ||||||||
| FaxNumber: | 2108881279 | ||||||||
| Practice Location | |||||||||
| Address1: | 7909 PAT BOOKER RD | ||||||||
| Address2: | |||||||||
| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782332602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106532400 | ||||||||
| FaxNumber: | 2106532422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2013 | ||||||||
| LastUpdateDate: | 08/20/2013 | ||||||||
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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 | 1232143 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.