Provider Demographics
NPI:1043764434
Name:BEAN, JASMINN (DPT)
Entity Type:Individual
Prefix:
First Name:JASMINN
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WIDGER RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2146
Mailing Address - Country:US
Mailing Address - Phone:781-631-8250
Mailing Address - Fax:315-468-1201
Practice Address - Street 1:1 WIDGER RD
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945
Practice Address - Country:US
Practice Address - Phone:781-631-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040367225100000X
MA24044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist