Individual
KEVIN B. BEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
402 W. LAKE ST., FRIENDSHIP, WI 53934
(608) 339-3331
Mailing address
402 W. LAKE ST., P.O. BOX 40, FRIENDSHIP, WI 53934
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5389
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40317300
—
WI
Enumeration date
05/07/2007
Last updated
07/08/2007
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