Provider Demographics
NPI:1902891443
Name:BEUTEL, DAVID M (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:BEUTEL
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:7445 EAST STATE STREET
Mailing Address - Street 2:HEIT REHABILITATION & OPTIMAL HEALTH CENTER SC
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2678
Mailing Address - Country:US
Mailing Address - Phone:815-399-5860
Mailing Address - Fax:815-399-6107
Practice Address - Street 1:7445 EAST STATE STREET
Practice Address - Street 2:HEIT REHABILITATION & OPTIMAL HEALTH CENTER SC
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2678
Practice Address - Country:US
Practice Address - Phone:815-399-5860
Practice Address - Fax:815-399-6107
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2012-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL070009239225100000X
IL070.009239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14474Medicare UPIN