Healthcare Provider Details

I. General information

NPI: 1225011935
Provider Name (Legal Business Name): ROBERT CHARLES BEBA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1788 REPUBLIC RD SUITE 100
VIRGINIA BEACH VA
23454-4552
US

IV. Provider business mailing address

PO BOX 5982
VIRGINIA BEACH VA
23471-0982
US

V. Phone/Fax

Practice location:
  • Phone: 757-437-0412
  • Fax: 757-437-4582
Mailing address:
  • Phone: 757-437-0412
  • Fax: 757-437-4582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305005691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: