Provider Demographics
NPI:1477843274
Name:BEAL, BENJAMIN H (MS, PT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:H
Last Name:BEAL
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 REPUBLIC PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6926
Mailing Address - Country:US
Mailing Address - Phone:972-698-1140
Mailing Address - Fax:972-681-8753
Practice Address - Street 1:1650 REPUBLIC PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6926
Practice Address - Country:US
Practice Address - Phone:972-698-1140
Practice Address - Fax:972-681-8753
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11362162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic