Provider Demographics
NPI:1033158506
Name:BEERY, JEREMIAH (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:
Last Name:BEERY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5008-190
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338
Mailing Address - Country:US
Mailing Address - Phone:209-966-2251
Mailing Address - Fax:209-966-2771
Practice Address - Street 1:5008 HIGHWAY 140 UNIT B
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-2434
Practice Address - Country:US
Practice Address - Phone:209-966-2251
Practice Address - Fax:209-966-2771
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHF776ZMedicare PIN