Provider Demographics
NPI:1962799650
Name:BEITMAN, LISA (MPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BEITMAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 CUSTIS RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-2011
Mailing Address - Country:US
Mailing Address - Phone:267-251-3015
Mailing Address - Fax:
Practice Address - Street 1:255 SKIPPACK PIKE
Practice Address - Street 2:SUITE 130
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422
Practice Address - Country:US
Practice Address - Phone:215-591-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015768261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028229160001Medicaid