Provider Demographics
NPI:1396825774
Name:BEAL, JENNIFER GWEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GWEN
Last Name:BEAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6461 SPARTINA CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-1811
Mailing Address - Country:US
Mailing Address - Phone:561-747-5184
Mailing Address - Fax:561-747-5184
Practice Address - Street 1:2505 METROCENTRE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3114
Practice Address - Country:US
Practice Address - Phone:561-688-1844
Practice Address - Fax:561-688-1845
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT 4764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU3843ZMedicare PIN