Provider Demographics
NPI:1437413622
Name:BEEBE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BEEBE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:A
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:501-882-2260
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-0297
Mailing Address - Country:US
Mailing Address - Phone:501-882-2260
Mailing Address - Fax:501-882-2369
Practice Address - Street 1:710 W DEWITT HENRY DR STE D
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2102
Practice Address - Country:US
Practice Address - Phone:501-882-2260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty