Provider Demographics
NPI:1548982051
Name:BEAUDRY, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:BEAUDRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 HARTFORD TPKE STE U
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4834
Mailing Address - Country:US
Mailing Address - Phone:860-645-3810
Mailing Address - Fax:860-645-3814
Practice Address - Street 1:586 MIDDLE TPKE E
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3730
Practice Address - Country:US
Practice Address - Phone:606-453-8108
Practice Address - Fax:860-645-3814
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13705225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist