Theresa Marie Beauregard, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2601000296 Issued in MI

Practice address

50505 Schoenherr Rd Ste 120
Shelby Township, MI 48315-3140

Phone

(586) 710-2306

Fax

(586) 412-4626

NPI assigned

Jan 31, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646179200000",
    "number": "1154468825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 BELLE RIVER RD",
            "city": "CHINA",
            "state": "MI",
            "postal_code": "480543306",
            "telephone_number": "586-291-1335",
            "fax_number": "586-412-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50505 SCHOENHERR RD STE 120",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483153140",
            "telephone_number": "586-710-2306",
            "fax_number": "586-412-4626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24715 Little Mack Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Saint Clair Shores",
            "state": "MI",
            "postal_code": "480803207",
            "country_code": "US",
            "telephone_number": "586-779-7970",
            "fax_number": "586-779-7748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BEAUREGARD",
        "first_name": "THERESA",
        "middle_name": "MARIE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-31",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tala Bayasi
• Stephanie Bazydlo, RD
• Elyse Delphine Johnson Beach, M.S., CF-SLP
• Cheyenne Beard
• Karen L Beasley, MD
• Alec R Beck
• Laura Michelle-Levy Bednarsh
• Michelle Jennifer Bedont
• Vasjola Bekolli, DDS
• Monica Bell, OTRL

• Athletic Trainer in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.