Individual
JOHN CHRISTOPHER BEAUCHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
503 MINORS DR, MUKWONAGO, WI 53149-9413
(414) 640-2372
(262) 363-5227
Mailing address
503 MINORS DR, MUKWONAGO, WI 53149-9413
(414) 640-2372
(262) 363-5227
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 5600-024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00077444470
AETNA ID
WI
01
—
11231010
CAQH PROVIDER ID
WI
01
—
200009840014
BLUE CROSS BLUE SHIELD
WI
01
—
2128442
FIRST HEALTH ID
WI
01
—
610442200
OWCP, US DEPT. OF LABOR
WI
01
—
PT 5600-024
PT LICENSE
WI
Enumeration date
09/04/2006
Last updated
04/17/2013
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