Provider Demographics
NPI:1437396090
Name:BEENKEN, TYANN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:TYANN
Middle Name:MARIE
Last Name:BEENKEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:TYANN
Other - Middle Name:MARIE
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:BUFFALO CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50424-0185
Mailing Address - Country:US
Mailing Address - Phone:515-320-2354
Mailing Address - Fax:
Practice Address - Street 1:125 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO CENTER
Practice Address - State:IA
Practice Address - Zip Code:50424-7731
Practice Address - Country:US
Practice Address - Phone:515-320-2354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist