Provider Demographics
NPI:1093459562
Name:BEAMESDERFER, LONNA
Entity Type:Individual
Prefix:
First Name:LONNA
Middle Name:
Last Name:BEAMESDERFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1806
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-1806
Mailing Address - Country:US
Mailing Address - Phone:216-772-1030
Mailing Address - Fax:
Practice Address - Street 1:7727 AUGUSTA PINES DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-2179
Practice Address - Country:US
Practice Address - Phone:216-772-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist