Healthcare Provider Details

I. General information

NPI: 1275948531
Provider Name (Legal Business Name): BEAU BELOW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W MOHAWK DR
TOMAHAWK WI
54487-2215
US

IV. Provider business mailing address

225 THEILER DR
TOMAHAWK WI
54487-1733
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-7600
  • Fax:
Mailing address:
  • Phone: 715-216-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1993-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: