| Organization Name: | BEAVER MEDICAL GROUP, LP |
| NPI Number: | 1427090281 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LEROY L OUNANIAN (MEDICAL DIRECTOR) |
| Mailing Address: | 245 Terracina Blvd Suite # 105 Redlands |
| State: | CA US |
| Postal Code: | 923734852 |
| Phone Number: | 9097929737 |
| Fax Number: | 9097964158 |
| NPI Enumeration Date: | 06/13/2006 |
| NPI Last Update Date: | 04/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 09/10/2009 |
| NPI Reactivation Date: | 11/09/2012 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |