Basic Information
| Provider Information | |||||||||
| NPI: | 1730335415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEECHER | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 BYWATER LN | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066053115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312415405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 35 RIVER RD | ||||||||
| Address2: | 2ND FLOOR (PERFORMANCE PHYSICAL THERAPY) | ||||||||
| City: | COS COB | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068072759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034220679 | ||||||||
| FaxNumber: | 2034220931 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 11/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5775 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 008584 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 008584 | 01 | CT | STATE | OTHER | 5775 | 01 | SC | LICENSE | OTHER |