Individual
MRS. JILL KELLEY BEASENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
856 GRANNYS LN, AWENDAW, SC 29429-6060
(843) 259-4633
(843) 388-4498
Mailing address
636 LONG POINT RD UNIT G, MT PLEASANT, SC 29464-8286
(843) 259-4633
(843) 388-4498
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
4236
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH1534
—
SC
Enumeration date
05/10/2006
Last updated
05/03/2019
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