Provider Demographics
NPI:1942756259
Name:BEBERMEYER, ALEEAH
Entity Type:Individual
Prefix:
First Name:ALEEAH
Middle Name:
Last Name:BEBERMEYER
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:73 W FOURTH ST.
Practice Address - Street 2:
Practice Address - City:SUTTON BAY
Practice Address - State:MI
Practice Address - Zip Code:49682
Practice Address - Country:US
Practice Address - Phone:231-271-3939
Practice Address - Fax:231-271-3959
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004883225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant