Provider Demographics
NPI:1801612247
Name:BEASLEY, TABITHA (LMT)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 ELMSFORD DR
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3344
Mailing Address - Country:US
Mailing Address - Phone:716-254-1603
Mailing Address - Fax:
Practice Address - Street 1:5020 ARMOR DUELLS RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-4441
Practice Address - Country:US
Practice Address - Phone:716-254-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032855225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist