Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | J1-0001410 | DE |
NPI | 1003238502 |
---|---|
Provider Name | Jason Paul Beaman |
First Address | Wilmington, DE 19808-1527 |
Second Address | Wilmington, DE 19808-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2014 |
Last Update Date | 17/01/2014 |