MEDICARE: MRS. LAURA U BEEBE MPT

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	19980	MD

General Provider Information

NPI Number	:	1760561039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA U BEEBE MPT

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	10039 BALTIMORE NATIONAL PIKE STE L
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-4044
Country	:	US
Telephone Number	:	410-988-4319
Fax Number	:	410-844-0289

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/07/2022

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