Provider Demographics
NPI:1265449680
Name:BEACH, MARY L (DPT, MS, OCS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:BEACH
Suffix:
Gender:F
Credentials:DPT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 CEDAR WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-2068
Mailing Address - Country:US
Mailing Address - Phone:412-826-2344
Mailing Address - Fax:412-826-8350
Practice Address - Street 1:527 CEDAR WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2068
Practice Address - Country:US
Practice Address - Phone:412-826-2344
Practice Address - Fax:412-826-8350
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001957E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
109672Medicare PIN