Provider Demographics
NPI:1780962191
Name:BEADLE, DANEITH R
Entity type:Individual
Prefix:
First Name:DANEITH
Middle Name:R
Last Name:BEADLE
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 1:1810 BRUCKNER BLVD
Mailing Address - Street 2:APT # 6F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-3745
Mailing Address - Country:US
Mailing Address - Phone:646-685-9776
Mailing Address - Fax:
Practice Address - Street 1:1810 BRUCKNER BLVD
Practice Address - Street 2:APT # 6F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-3745
Practice Address - Country:US
Practice Address - Phone:646-685-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0063011225200000X
NY0362941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist