Basic Information
| Provider Information | |||||||||
| NPI: | 1538826748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEENE | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | SANCHEZE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 MARKET CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380176913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018619970 | ||||||||
| FaxNumber: | 9018619971 | ||||||||
| Practice Location | |||||||||
| Address1: | 8110 CAMP CREEK RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | OLIVE BRANCH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386541622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628931933 | ||||||||
| FaxNumber: | 6628931934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2021 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14003 | TN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | CP003037T | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.