Basic Information
| Provider Information | |||||||||
| NPI: | 1912213489 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEVERLEY | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1952 ABERDEEN CT | ||||||||
| Address2: | |||||||||
| City: | SYCAMORE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601783175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157580000 | ||||||||
| FaxNumber: | 8157580094 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 N MAIN ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SANDWICH | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605481394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157866000 | ||||||||
| FaxNumber: | 8157863603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.