Tyler Beauchamp, PTA, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

080342 Issued in IA

Practice address

6101 Northwest Blvd
Davenport, IA 52806-1861

Phone

(563) 449-7004

NPI assigned

Oct 22, 2020

Sex

Male

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": "1603324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1700485505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 NORTHWEST BLVD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528061861",
            "telephone_number": "563-449-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 NORTHWEST BLVD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528061861",
            "telephone_number": "563-449-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUCHAMP",
        "first_name": "TYLER",
        "credential": "PTA, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IA",
            "license": "105325",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IA",
            "license": "080342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate Beardsley, LISW
• Marianna Rebecca Beattie Vonmuenster, DDS
• Matthew Camfield Beattie, DDS
• Dean J Beauchamp, ATC
• Megan Beauchamp, RBT
• Michael Earl Beck, DDS
• Nicklas Dean Beck, DO
• Zoe Ellen Beck, DO
• Hannah Elizabeth Becker, NP-C
• Bee Well Child and Family Therapy

• Athletic Trainer in Davenport, IA
• Providers in Davenport, IA by specialty
• Athletic Trainer in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.