Healthcare Provider Details

I. General information

NPI: 1356821722
Provider Name (Legal Business Name): JEREMY BECKMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 BALTIC AVE
EDINBURG TX
78539-7773
US

IV. Provider business mailing address

2521 EMORY AVE
MCALLEN TX
78504-5730
US

V. Phone/Fax

Practice location:
  • Phone: 956-316-2533
  • Fax:
Mailing address:
  • Phone: 956-566-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2059780
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: