Provider Demographics
NPI:1407537657
Name:BEAM, JANIS KATHLEEN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:KATHLEEN
Last Name:BEAM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:JANIS
Other - Middle Name:KATHLEEN
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MANDARIN LN
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-3001
Mailing Address - Country:US
Mailing Address - Phone:765-414-1803
Mailing Address - Fax:
Practice Address - Street 1:1200 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4450
Practice Address - Country:US
Practice Address - Phone:407-201-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4223225200000X
FLPTA32927225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant