Provider Demographics
NPI:1902189244
Name:BEAMER, DIANE J (PHD)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:J
Last Name:BEAMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:J
Other - Last Name:BEAMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:5209 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-4508
Mailing Address - Country:US
Mailing Address - Phone:847-293-4696
Mailing Address - Fax:
Practice Address - Street 1:5209 ELLIOTT DR
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-4508
Practice Address - Country:US
Practice Address - Phone:847-293-4696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist