Provider Demographics
NPI:1629786033
Name:BEYENE, SALEM
Entity Type:Individual
Prefix:
First Name:SALEM
Middle Name:
Last Name:BEYENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 E APACHE BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85288-4935
Mailing Address - Country:US
Mailing Address - Phone:602-793-3603
Mailing Address - Fax:
Practice Address - Street 1:2428 E APACHE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85288-4935
Practice Address - Country:US
Practice Address - Phone:602-793-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)