Healthcare Provider Details

I. General information

NPI: 1972295889
Provider Name (Legal Business Name): JARRETT BEAVER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 18TH ST SE
HICKORY NC
28602-1363
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 828-485-2160
  • Fax:
Mailing address:
  • Phone: 704-323-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP22229
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: