Healthcare Provider Details

I. General information

NPI: 1235554320
Provider Name (Legal Business Name): BEEBE HEALTHYBACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21635 BIDEN AVE SUITE 207
GEORGETOWN DE
19947-4574
US

IV. Provider business mailing address

21635 BIDEN AVE SUITE 207
GEORGETOWN DE
19947-4574
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3213
  • Fax:
Mailing address:
  • Phone: 302-645-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateDE

VIII. Authorized Official

Name: MR. RANDY LUBINSKY
Title or Position: DIRECTOR
Credential:
Phone: 407-257-9510