Domonique Shantae Beckham, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1359208 Issued in TX

Practice address

138 Old San Antonio Rd Ste 304
Boerne, TX 78006-3491

Phone

(210) 419-3144

Fax

(210) 764-5098

NPI assigned

Nov 2, 2018

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068

  GA, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Benchmark Healthcare Services, LLC

  • Physical Therapist
  • Ooltewah, TN
  • NPI 1811213341

  Physical Therapist, SC

  Medicare reassignment NPD
• Panorama Orthopedics and Spine Center PC

  • Orthopaedic Surgery Physician
  • Golden, CO
  • NPI 1295787950

  CO

  Medicare reassignment NPD
• Independent Physical Therapy of Georgia, LLC

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  Care Compare group NPD
• Agilitas USA Inc

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1962417444

  GA

  Medicare reassignment
• Independent Physical Therapy of Ga, LLC

  • Physical Therapist
  • Dawsonville, GA
  • NPI 1386515955
  Care Compare group
• Independent Physical Therapy of Ga, LLC

  • Physical Therapist
  • Blairsville, GA
  • NPI 1588931190
  Care Compare group
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapy Clinic/Center
  • Marietta, GA
  • NPI 1013292119
  Care Compare group
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Hoschton, GA
  • NPI 1124295779
  Care Compare group
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Canton, GA
  • NPI 1457608861
  Care Compare group
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Demorest, GA
  • NPI 1467556829
  Care Compare group
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Dahlonega, GA
  • NPI 1487962684
  Care Compare group

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Physical Therapy of Georgia, LLC 526 clinicians

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in GA, SC, CO3 enrollments

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 15, 2022.

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1780152272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 OLD SAN ANTONIO RD STE 304",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780063491",
            "telephone_number": "210-419-3144",
            "fax_number": "210-764-5098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3627 SE 29th St Ste 107",
            "address_purpose": "LOCATION",
            "city": "Topeka",
            "state": "KS",
            "postal_code": "666052013",
            "country_code": "US",
            "telephone_number": "785-266-4600",
            "fax_number": "785-266-4601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BECKHAM",
        "first_name": "DOMONIQUE",
        "middle_name": "SHANTAE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-02",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-07109",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT013764",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1359208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Denise Beard
• Jacqueline Beauchamp, RN
• Kristine Lynne Beauchamp, M.D.
• Jaime Beaumont, PTA
• Chelsea Beck-Smith
• Amber Dian Beckworth
• Becoming Whole Counseling, PLLC
• Nancy Diane Beebe, RN, FNP-BC
• Bruce Charles Begia, M.D.
• Tamara Begley, RN

• All providers in Boerne, TX
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.