Provider Demographics
NPI:1912126624
Name:BESHAY, MAHER (RPT)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:
Last Name:BESHAY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10916 SE TIMUCUAN RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4651
Mailing Address - Country:US
Mailing Address - Phone:352-454-8322
Mailing Address - Fax:352-307-4064
Practice Address - Street 1:13795 SW 36TH AVENUE RD STE 5
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34473-6104
Practice Address - Country:US
Practice Address - Phone:352-307-0766
Practice Address - Fax:352-307-4064
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY022POtherBCBS
FLK4236Medicare ID - Type Unspecified