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

Last updated

Aug 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, SC, CO3 enrollments

Enrollment records 3

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, LLCGroup PAC ID 2961312244, 526 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Independent Physical Therapy of Georgia, LLC

  dba BenchMark Physical Therapy

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment Care Compare group NPD
• Benchmark Healthcare Services, LLC

  • Physical Therapist
  • Ooltewah, TN
  • NPI 1811213341

  SC

  Medicare reassignment NPD
• Panorama Orthopedics and Spine Center PC

  • Orthopaedic Surgery Physician
  • Golden, CO
  • NPI 1295787950
  Medicare reassignment NPD
• Agilitas USA Inc

  dba Results Physiotherapy

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

  GA

  Medicare reassignment
• Benchmark Health Services

  • Physical Therapist
  • Easley, SC
  • NPI 1457842643
  NPD
• Drayer Physical Therapy Institute LLC

  • Physical Therapist
  • York, PA
  • NPI 1053348409
  NPD
• Drayer Physical Therapy Institute LLC

  • Physical Therapist
  • Hummelstown, PA
  • NPI 1538122700
  NPD
• Independent Physical Therapy of Georgia, LLC

  dba Benchmark PT

  • Occupational Therapist
  • Gainesville, GA
  • NPI 1306013941

  Physical Therapist

  NPD
• Independent Physical Therapy of Georgia, LLC

  • Physical Therapy Clinic/Center
  • Buford, GA
  • NPI 1740547850
  NPD
• Panorama Orthopedics & Spine Center, PC

  • Physical Therapy Clinic/Center
  • Colorado Springs, CO
  • NPI 1194390518
  NPD
• Panorama Orthopedics and Spine Center PC

  dba Rocky Mountain Spine & Sport

  • Physical Therapy Clinic/Center
  • Denver, CO
  • NPI 1467052258
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "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

• Physical Therapist in Boerne, TX
• Providers in Boerne, TX by specialty
• 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.