Provider Demographics
NPI:1871566034
Name:BEALS, MARNI MARIE (ATC, LMT)
Entity type:Individual
Prefix:MRS
First Name:MARNI
Middle Name:MARIE
Last Name:BEALS
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1138
Mailing Address - Country:US
Mailing Address - Phone:312-236-0660
Mailing Address - Fax:312-236-1219
Practice Address - Street 1:20 N MICHIGAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4811
Practice Address - Country:US
Practice Address - Phone:312-236-0660
Practice Address - Fax:312-236-1219
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist