Provider Demographics
NPI:1205824315
Name:BEAM, MELVIN (PT)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:BEAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FRANKLIN RD STE 135A-102
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3280
Mailing Address - Country:US
Mailing Address - Phone:760-220-2889
Mailing Address - Fax:509-863-9149
Practice Address - Street 1:765 E HOLLAND AVE STE 3
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1280
Practice Address - Country:US
Practice Address - Phone:509-824-1996
Practice Address - Fax:509-684-5817
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8382012Medicaid
WA8808031Medicare ID - Type Unspecified
WA8382012Medicaid