Provider Demographics
NPI:1083682447
Name:HASTINGS, BEVERLEE JEANNE (MPT)
Entity Type:Individual
Prefix:MS
First Name:BEVERLEE
Middle Name:JEANNE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3536
Mailing Address - Country:US
Mailing Address - Phone:650-366-5811
Mailing Address - Fax:
Practice Address - Street 1:987 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7640
Practice Address - Country:US
Practice Address - Phone:408-395-7300
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist