Organization
BEACON HEALTH, LLC
Active
Other names
Beacon Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY PETER COSTELLO (CFO)
(574) 647-3460
Entity
Organization
Contact information
Practice address
3221 BEACON PARKWAY STE 100, GRANGER, IN 46530-7196
(574) 647-2930
(574) 647-2935
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300008838
—
IN
05
—
300009047
—
IN
05
—
300009541
—
IN
05
—
300024766
—
IN
05
—
300063973
—
IN
Enumeration date
10/11/2017
Last updated
02/04/2026
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