Provider Demographics
NPI:1710483631
Name:BEUKEMA, LORNA S (PT)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:S
Last Name:BEUKEMA
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 1:329 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2511
Mailing Address - Country:US
Mailing Address - Phone:650-759-7448
Mailing Address - Fax:650-249-4238
Practice Address - Street 1:1660 S AMPHLETT BLVD STE 116
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2507
Practice Address - Country:US
Practice Address - Phone:650-453-5100
Practice Address - Fax:650-453-5100
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist