Provider Demographics
NPI:1447463625
Name:BEARD, JONATHAN ALLEN (PT)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:BEARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16104 REDINGTON DR
Mailing Address - Street 2:
Mailing Address - City:REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1631
Mailing Address - Country:US
Mailing Address - Phone:210-710-9279
Mailing Address - Fax:
Practice Address - Street 1:812 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5642
Practice Address - Country:US
Practice Address - Phone:727-441-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist