Provider Demographics
NPI:1265651913
Name:BEERS, MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BEERS
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 1:790 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:630-759-9510
Practice Address - Street 1:3155 W CRAIG RD STE 140
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0783
Practice Address - Country:US
Practice Address - Phone:702-639-2333
Practice Address - Fax:702-639-2334
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-015632225100000X
NV3464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619908OtherBCBS IL GROUP NUMBER
IL567700OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL568080OtherMEDICARE GROUP NUMBER
ILK49085Medicare PIN
IL568150OtherMEDICARE GROUP NUMBER
ILK49086Medicare PIN
IL567700OtherMEDICARE GROUP NUMBER