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NPI Code Detail

MEDICARE: SHANNA N. BEACH PT

MEDICARE: SHANNA N. BEACH PT
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
1225100000XPhysical Therapist4253AZ

General Provider Information

NPI Number : 1255302204
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNA N. BEACH PT
Provider Business Mailing Address
First Line : 2956 S VALLE VERDE
Second Line :
City : MESA
State : AZ
Zip : 85212-1829
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1802 W PARKSIDE LN
Second Line :
City : PHOENIX
State : AZ
Zip : 85027-1322
Country : US
Telephone Number : 602-943-5472
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2006
Last Update Date : 07/08/2007

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