MEDICARE: JEROME BEELER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2274	NV

General Provider Information

NPI Number	:	1780827584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME BEELER DPT

Provider Business Mailing Address
First Line	:	2851 N TENAYA WAY STE 205
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0453
Country	:	US
Telephone Number	:	702-655-3456
Fax Number	:	702-655-9594

Provider Business Practice Location Address
First Line	:	7455 W WASHINGTON AVE STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4338
Country	:	US
Telephone Number	:	702-655-9456
Fax Number	:	702-243-1830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2009
Last Update Date	:	04/12/2022

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Directions to “ JEROME BEELER DPT” Practice Location

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