=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003238502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON PAUL BEAMAN P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2014
-----------------------------------------------------
Last Update Date | 01/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 NEWGATE LN
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-636-9363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 NEWGATE LN
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-636-9363
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | J1-0001410
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------