Provider Demographics
NPI:1538826748
Name:BEENE, FREDERICK SANCHEZE (PT)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:SANCHEZE
Last Name:BEENE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 MARKET CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-6913
Mailing Address - Country:US
Mailing Address - Phone:901-861-9970
Mailing Address - Fax:901-861-9971
Practice Address - Street 1:8110 CAMP CREEK RD STE 106
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1622
Practice Address - Country:US
Practice Address - Phone:662-893-1933
Practice Address - Fax:662-893-1934
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14003225100000X
MSCP003037T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty