Provider Demographics
NPI:1093014243
Name:BEERY, JOHN AUSTIN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AUSTIN
Last Name:BEERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:AUSTIN
Other - Last Name:BEERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:828 N HOMER RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8616
Mailing Address - Country:US
Mailing Address - Phone:989-839-9529
Mailing Address - Fax:989-839-9529
Practice Address - Street 1:828 N HOMER RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8616
Practice Address - Country:US
Practice Address - Phone:989-839-9529
Practice Address - Fax:989-839-9529
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-26
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000425261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy