Healthcare Provider Details

I. General information

NPI: 1942756259
Provider Name (Legal Business Name): ALEEAH BEBERMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 W FOURTH ST.
SUTTON BAY MI
49682
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 231-271-3939
  • Fax: 231-271-3959
Mailing address:
  • Phone: 630-296-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502004883
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: