Healthcare Provider Details

I. General information

NPI: 1639470313
Provider Name (Legal Business Name): MS. GINA LEANN BEECHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA LEANN BRUELLMAN DPT

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SW ANKENY RD
ANKENY IA
50023-9798
US

IV. Provider business mailing address

715 SW ANKENY RD
ANKENY IA
50023-9798
US

V. Phone/Fax

Practice location:
  • Phone: 515-965-1339
  • Fax: 515-965-1186
Mailing address:
  • Phone: 515-965-1339
  • Fax: 515-965-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004456
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: