Provider Demographics
NPI:1497757371
Name:BEASLEY, TAMSEN LATRELLE (PT, CHT)
Entity type:Individual
Prefix:
First Name:TAMSEN
Middle Name:LATRELLE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:762-235-2700
Practice Address - Fax:706-236-6437
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004343225100000X
AL15940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
582308747OtherSTATE HEALTH
582308747OtherACCORDIA
GA00625842CMedicaid
GA00625842FMedicaid
582308747OtherUNITED HEALTHCARE
GA00625842EMedicaid
5142439582308747OtherAETNA
582308747OtherPHCS
GA00625842DMedicaid
1082149OtherFIRST HEALTH
21168648367OtherBEECHSTREET
655245OtherBCBS GA
AL890012840Medicaid
AL890012850Medicaid
GA116779Medicare ID - Type Unspecified