Provider Demographics
NPI:1508408881
Name:BEIRNE, JIMMIE TYLER (DPT)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:TYLER
Last Name:BEIRNE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 FEELY LN
Mailing Address - Street 2:
Mailing Address - City:ONA
Mailing Address - State:WV
Mailing Address - Zip Code:25545-9762
Mailing Address - Country:US
Mailing Address - Phone:304-633-3882
Mailing Address - Fax:
Practice Address - Street 1:4011 FEELY LN
Practice Address - Street 2:
Practice Address - City:ONA
Practice Address - State:WV
Practice Address - Zip Code:25545-9762
Practice Address - Country:US
Practice Address - Phone:304-633-3882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT003667261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy