Healthcare Provider Details

I. General information

NPI: 1184932998
Provider Name (Legal Business Name): REBECCA MARY BEISHLINE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BERWICK RD
ORANGEVILLE PA
17859-9064
US

IV. Provider business mailing address

17 WINDSOR LN
STILLWATER PA
17878-9432
US

V. Phone/Fax

Practice location:
  • Phone: 570-683-8511
  • Fax: 570-683-5403
Mailing address:
  • Phone: 570-925-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE1000856
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: