Provider Demographics
NPI:1417027368
Name:BEACH, DENA (PT)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77-6449 PUALANI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9768
Mailing Address - Country:US
Mailing Address - Phone:808-756-0503
Mailing Address - Fax:
Practice Address - Street 1:77-6449 PUALANI ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-9768
Practice Address - Country:US
Practice Address - Phone:808-756-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA016OtherTRICARE
HI9221294OtherUHA
HI567208-01Medicaid
HI56720800OtherALOHACARE
HI00A0234268OtherHMSA/BCBS