Provider Demographics
NPI:1215986302
Name:BEAMER, MARY SUSAN (PT, MA, CHT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUSAN
Last Name:BEAMER
Suffix:
Gender:F
Credentials:PT, MA, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HAWK CT
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5709
Mailing Address - Country:US
Mailing Address - Phone:847-798-6513
Mailing Address - Fax:
Practice Address - Street 1:1443 W SCHAUMBURG RD
Practice Address - Street 2:STE 102
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-4065
Practice Address - Country:US
Practice Address - Phone:847-895-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070005208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1619980OtherBCBS OF IL
IL568150Medicare PIN
IL568080Medicare PIN
IL1619980OtherBCBS OF IL
IL568150002Medicare PIN
IL567700Medicare PIN
IL568080002Medicare PIN