Provider Demographics
NPI:1356539811
Name:BEDUYA, BEVERLY JOSEPHINE (PT)
Entity type:Individual
Prefix:MISS
First Name:BEVERLY
Middle Name:JOSEPHINE
Last Name:BEDUYA
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:P.O. BOX 3683
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91394
Mailing Address - Country:US
Mailing Address - Phone:818-357-8977
Mailing Address - Fax:
Practice Address - Street 1:17400 MINNEHAHA ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6046
Practice Address - Country:US
Practice Address - Phone:818-357-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27606225100000X
CAPT27606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist