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General NPI Number Information
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NPI Number | 1972005775
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Entity Type | Individual
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Provider Name | ELIZABETH BEEBANI
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Gender | Female
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 3031 W GRAND BLVD STE 700
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City | DETROIT
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State | MI
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Zip | 48202-3141
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Country | US
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Telephone | 313-916-3162
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Fax | 313-916-7988
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Provider Business Mailing Address
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Address Line | 816 W MARSHALL ST
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City | FERNDALE
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State | MI
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Zip | 48220-1639
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Country | US
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Telephone | 313-408-2514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017950
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License Number State | MI
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