Healthcare Provider Details

I. General information

NPI: 1548086564
Provider Name (Legal Business Name): WHITMAN BEITEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N 6TH ST
REDLANDS CA
92373-5226
US

IV. Provider business mailing address

55 ORANGEWOOD CT
REDLANDS CA
92373-1442
US

V. Phone/Fax

Practice location:
  • Phone: 909-855-8562
  • Fax:
Mailing address:
  • Phone: 909-855-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: