Lisa Danette Beaudry, PT, DPT
Individual provider Active NPI Physical Therapist · Jamestown, NY
NPI 1376566752 · NPPES record last updated Mar 26, 2015
Key facts
- NPI
- 1376566752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 022328 (NY)
- Practice address
- 774 Fairmount Ave
Jamestown
Jamestown, NY 14701-2609 - Phone
- (716) 665-1166
- Fax
- (866) 902-1160
- NPI assigned
- Jul 26, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rehabilitation Specialists Physical Therapy, Occupational Therapy, Spe
Practice addresses (Care Compare)
774 Fairmount Ave
Jamestown, NY 14701-2609
Phone (716) 665-1166
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111027000020 | NY | Practitioner - Physical Therapist in Private Practice | 1153593637 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 022328 | NY | Yes |
Addresses
Primary practice location
774 Fairmount Ave
Jamestown
Jamestown, NY 14701-2609
Mailing address
774 Fairmount Ave
Jamestown
Jamestown, NY 14701-2609
Phone (716) 665-1166
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02163564 | Medicaid | NY |
Other providers in Jamestown, NY
- Ercel Basilio
- Mariah Mary Earlene Battle
- William Baumgratz
- Bay City Orthocare, LLC
- Amy Rebecca Beach
- Heather Becker
- Laurie K White Bedient
- Scott H Bedwell
- Connor C Bell
- Katie Marie Bell
All providers in Jamestown, NY · Physical Therapist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.