Provider Demographics
NPI:1114416229
Name:BEAMAN, KRISTA MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MARIE
Last Name:BEAMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3239
Mailing Address - Country:US
Mailing Address - Phone:812-314-2378
Mailing Address - Fax:812-373-7616
Practice Address - Street 1:4610 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3239
Practice Address - Country:US
Practice Address - Phone:812-314-2378
Practice Address - Fax:812-373-7616
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012893A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist