Provider Demographics
NPI:1235554320
Name:BEEBE HEALTHYBACK LLC
Entity Type:Organization
Organization Name:BEEBE HEALTHYBACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-257-9510
Mailing Address - Street 1:21635 BIDEN AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-4574
Mailing Address - Country:US
Mailing Address - Phone:302-645-3213
Mailing Address - Fax:
Practice Address - Street 1:21635 BIDEN AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-4574
Practice Address - Country:US
Practice Address - Phone:302-645-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPENDINGMedicare Oscar/Certification