MEDICARE: BEEVILLE PHYSICAL THERAPY, PLLC

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	261QP2000X	Physical Therapy Clinic/Center	1181756	TX

General Provider Information

NPI Number	:	1982016804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEEVILLE PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1406 E HOUSTON ST
Second Line	:	D
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5346
Country	:	US
Telephone Number	:	361-542-4652
Fax Number	:	361-542-4653

Provider Business Practice Location Address
First Line	:	1406 E HOUSTON ST
Second Line	:	D
City	:	BEEVILLE
State	:	TX
Zip	:	78102-5346
Country	:	US
Telephone Number	:	361-542-4652
Fax Number	:	361-542-4653

Authorized Official
Title or Position	:	PHYSICAL THERAPY DIRECTOR
Name	:	ERIN CELESTE DIAL
Credential	:	PT
Telephone Number	:	361-542-4652

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	05/27/2014

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