Active NPI
Vivian Orlynne Beauchamp, P.T.
- Physical Therapist
- Anderson, SC
National Provider Identifier
1104004944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1986
- Practice address
- 800 N Fant St
Anderson, SC 29621-5708 - Phone
- (864) 512-1196
- NPI assigned
- Feb 4, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1986 | SC | Primary |
Addresses
Primary practice location
800 N Fant St
Anderson, SC 29621-5708
Mailing address
800 N Fant St
Anderson, SC 29621-5708
Phone (864) 512-1196
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TH0360 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1986 | SC | MD | Clinical Neuropsychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1202083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202083200000",
"number": "1104004944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 N FANT ST",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296215708",
"telephone_number": "864-512-1196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 N FANT ST",
"city": "ANDERSON",
"state": "SC",
"postal_code": "296215708",
"telephone_number": "864-512-1196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BEAUCHAMP",
"first_name": "VIVIAN",
"middle_name": "ORLYNNE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-04",
"last_updated": "2008-02-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "1986",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "TH0360",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Anderson, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.