Provider Demographics
NPI:1225584436
Name:SINNER, BEAU (DPT)
Entity type:Individual
Prefix:
First Name:BEAU
Middle Name:
Last Name:SINNER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 156TH R AVE SE
Mailing Address - Street 2:PO BOX
Mailing Address - City:CASSELTON
Mailing Address - State:ND
Mailing Address - Zip Code:58012
Mailing Address - Country:US
Mailing Address - Phone:701-212-8318
Mailing Address - Fax:
Practice Address - Street 1:10000 W 75TH ST
Practice Address - Street 2:ST #250
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2209
Practice Address - Country:US
Practice Address - Phone:913-894-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist