Provider Demographics
NPI:1437908332
Name:BEAL, MICHAELYNNE
Entity type:Individual
Prefix:
First Name:MICHAELYNNE
Middle Name:
Last Name:BEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 E SHAWNEE BYP
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1446
Mailing Address - Country:US
Mailing Address - Phone:918-684-9999
Mailing Address - Fax:888-663-4223
Practice Address - Street 1:2244 E SHAWNEE BYP
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1446
Practice Address - Country:US
Practice Address - Phone:918-684-9999
Practice Address - Fax:888-663-4223
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3773225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant