Provider Demographics
NPI:1982880407
Name:BEITZEL, JAMES ALAN (LICSENCED ATHLETIC T)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALAN
Last Name:BEITZEL
Suffix:
Gender:M
Credentials:LICSENCED ATHLETIC T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 KNOLLWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4631
Mailing Address - Country:US
Mailing Address - Phone:630-232-0528
Mailing Address - Fax:
Practice Address - Street 1:2418 W INDIAN TRL
Practice Address - Street 2:SUITE G
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1589
Practice Address - Country:US
Practice Address - Phone:630-907-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL09600006402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer