Provider Demographics
NPI:1225399926
Name:HARASIM, BEATA LIDIA (DPT)
Entity type:Individual
Prefix:
First Name:BEATA
Middle Name:LIDIA
Last Name:HARASIM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BEATA
Other - Middle Name:LIDIA
Other - Last Name:HRYNKIEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 MAPLE TER # 2
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2814
Mailing Address - Country:US
Mailing Address - Phone:860-266-7745
Mailing Address - Fax:
Practice Address - Street 1:42 MAPLE TER # 2
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2814
Practice Address - Country:US
Practice Address - Phone:860-266-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.009372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist