MEDICARE: BEEBE PHYSICAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2923	AR

General Provider Information

NPI Number	:	1437413622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEEBE PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 297
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-0297
Country	:	US
Telephone Number	:	501-882-2260
Fax Number	:	501-882-2369

Provider Business Practice Location Address
First Line	:	710 W DEWITT HENRY DR STE D
Second Line	:
City	:	BEEBE
State	:	AR
Zip	:	72012-2102
Country	:	US
Telephone Number	:	501-882-2260
Fax Number	:

Authorized Official
Title or Position	:	PT/OWNER
Name	:	JACOB A LANDRUM
Credential	:	DPT
Telephone Number	:	501-882-2260

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	07/02/2012

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