Provider Demographics
NPI:1386175438
Name:BEAMAN, RONALD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:BEAMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1116
Mailing Address - Country:US
Mailing Address - Phone:402-426-3488
Mailing Address - Fax:402-426-3553
Practice Address - Street 1:636 N 20TH AVE
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1116
Practice Address - Country:US
Practice Address - Phone:402-426-3488
Practice Address - Fax:402-426-3553
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1188225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist