Provider Demographics
NPI:1063160133
Name:BEAM, RYEN BRADLEY (LMT)
Entity type:Individual
Prefix:
First Name:RYEN
Middle Name:BRADLEY
Last Name:BEAM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1670
Mailing Address - Country:US
Mailing Address - Phone:814-207-6706
Mailing Address - Fax:
Practice Address - Street 1:616 HILEMAN ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4643
Practice Address - Country:US
Practice Address - Phone:814-943-3033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG013302225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist