Provider Demographics
NPI:1447847876
Name:BEAUGH, JOSEPH RANDALL PAGE (PT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:RANDALL PAGE
Last Name:BEAUGH
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:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:404-367-2088
Mailing Address - Fax:706-692-1199
Practice Address - Street 1:620 J L WHITE DR STE 110
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4897
Practice Address - Country:US
Practice Address - Phone:404-367-2088
Practice Address - Fax:706-692-1199
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist