Healthcare Provider Details

I. General information

NPI: 1033158506
Provider Name (Legal Business Name): JEREMIAH BEERY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/20/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 HIGHWAY 140 UNIT B
MARIPOSA CA
95338-2434
US

IV. Provider business mailing address

PO BOX 5008-190
MARIPOSA CA
95338
US

V. Phone/Fax

Practice location:
  • Phone: 209-966-2251
  • Fax: 209-966-2771
Mailing address:
  • Phone: 209-966-2251
  • Fax: 209-966-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: