MEDICARE: RANEIKA SHIRRELLE BEAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	22491	MD

General Provider Information

NPI Number	:	1063686442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANEIKA SHIRRELLE BEAN

Provider Business Mailing Address
First Line	:	9440 PENNSYLVANIA AVE
Second Line	:	215
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9440 PENNSYLVANIA AVE
Second Line	:	215
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3659
Country	:	US
Telephone Number	:	301-599-8899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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Directions to “ RANEIKA SHIRRELLE BEAN ” Practice Location

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