Provider Demographics
NPI:1295458164
Name:BEAMER, SUZI MATHAI (LMT)
Entity type:Individual
Prefix:
First Name:SUZI
Middle Name:MATHAI
Last Name:BEAMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SE LEBLEU LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:OR
Mailing Address - Zip Code:97496-9201
Mailing Address - Country:US
Mailing Address - Phone:541-637-7993
Mailing Address - Fax:
Practice Address - Street 1:210 SE LEBLEU LN
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:OR
Practice Address - Zip Code:97496-9201
Practice Address - Country:US
Practice Address - Phone:541-637-7993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist