Provider Demographics
NPI:1235426495
Name:BEACH, DIONNE DENISE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:DENISE
Last Name:BEACH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DIONNE
Other - Middle Name:DENISE
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:792 N MAIN ST
Mailing Address - Street 2:STE 100C
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-458-2552
Mailing Address - Fax:315-458-2575
Practice Address - Street 1:358 MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:NY
Practice Address - Zip Code:13480-1116
Practice Address - Country:US
Practice Address - Phone:315-841-3222
Practice Address - Fax:315-841-4023
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist