Provider Demographics
NPI:1093502825
Name:B.E. PROACTIVE LLC
Entity type:Organization
Organization Name:B.E. PROACTIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BOAZ
Authorized Official - Middle Name:B
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-519-4273
Mailing Address - Street 1:1828 S EAST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8085
Mailing Address - Country:US
Mailing Address - Phone:316-519-4273
Mailing Address - Fax:
Practice Address - Street 1:1828 S EAST LAKE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8085
Practice Address - Country:US
Practice Address - Phone:316-519-4273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy