Provider Demographics
NPI:1386960771
Name:BEESON, DUSTIN WAYNE (PT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:WAYNE
Last Name:BEESON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 SAINT ANDREWS WAY
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3574
Mailing Address - Country:US
Mailing Address - Phone:479-653-4269
Mailing Address - Fax:
Practice Address - Street 1:4800 SAINT ANDREWS WAY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3574
Practice Address - Country:US
Practice Address - Phone:479-653-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR225100000X225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U349Medicare PIN