Individual provider Active NPI

Kylie Rae Beauchamp, PT, DPT

  • Physical Therapist
  • Monroe, GA
National Provider Identifier
1902572209
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT015510 Issued in GA
Practice address
705 Breedlove Dr Ste 200
Monroe, GA 30655-2080
Phone
(706) 549-1663
Fax
(706) 546-8792
NPI assigned
Aug 18, 2021
Last updated
Jun 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT015510 GA Primary

Addresses

Primary practice location

705 Breedlove Dr Ste 200
Monroe, GA 30655-2080

Mailing address

1765 Old West Broad St BLDG 2-200
Athens, GA 30606-2887
Phone (706) 549-1663

Other identifiers 1

IdentifierTypeStateIssuer
15630687OtherCAQH NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210928002668 GA Practitioner - Physical Therapist in Private Practice 3173920576 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

788 Prince Ave
Suite C
Athens, GA 30606-5912
Phone (706) 543-2111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT015510GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Human Performance and Rehabilitation Centers, LLC Physical Therapist CurrentSince Jun 4, 2025 Accepting new patients
Emory Physical Therapy, LLC CurrentSince Aug 25, 2021 Accepting new patients
Emory Physical Therapy, LLC CurrentSince Aug 25, 2021 Accepting new patients
Human Performance and Rehabilitation Centers LLC CurrentSince Jun 4, 2025 Accepting new patients
Emory Physical Therapy, LLC Current Accepting new patients

Locations

788 Prince Ave
Ste C
Athens, GA 30606
Phone (706) 453-2111

6298 Veterans Pkwy
Ste 5A
Columbus, GA 31909
Phone (706) 320-0927

1845 Satellite Blvd
Ste 750
Duluth, GA 30097
Phone (404) 778-6490

3903 S Cobb Dr SE
Ste 275
Smyrna, GA 30080
Phone (404) 251-2109

1650 Lyndon Farm Ct
Ste 300
Louisville, KY 40223
Phone (726) 202-3039

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1629244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748822400000",
    "number": "1902572209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 OLD WEST BROAD ST BLDG 2-200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062887",
            "telephone_number": "706-549-1663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 BREEDLOVE DR STE 200",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552080",
            "telephone_number": "706-549-1663",
            "fax_number": "706-546-8792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUCHAMP",
        "first_name": "KYLIE",
        "middle_name": "RAE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-18",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "15630687",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.