Provider Demographics
NPI:1104155688
Name:BEINN SONAS PHYSICAL THERAPY SERVICES
Entity type:Organization
Organization Name:BEINN SONAS PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:W
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:719-687-8034
Mailing Address - Street 1:12810 RAMPART RANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863
Mailing Address - Country:US
Mailing Address - Phone:719-687-8034
Mailing Address - Fax:719-533-1528
Practice Address - Street 1:12810 RAMPART RANGE ROAD
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-687-8034
Practice Address - Fax:719-533-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7810261QP2000X
CO7716261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy