Provider Demographics
NPI:1730335415
Name:BEECHER, MICHAEL (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BEECHER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BYWATER LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3115
Mailing Address - Country:US
Mailing Address - Phone:631-241-5405
Mailing Address - Fax:
Practice Address - Street 1:35 RIVER RD
Practice Address - Street 2:2ND FLOOR (PERFORMANCE PHYSICAL THERAPY)
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2759
Practice Address - Country:US
Practice Address - Phone:203-422-0679
Practice Address - Fax:203-422-0931
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5775225100000X
CT008584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008584OtherSTATE
SC5775OtherLICENSE
SC5775OtherLICENSE