=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235347766
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE D BEITEL L.M.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 170 S YONGE ST STE. A
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-6286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-673-0524
-----------------------------------------------------
Fax | 386-673-0539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 460 SAULS ST
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32174-7561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-672-1001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MA19045
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------