Provider Demographics
NPI:1598905481
Name:BEASOM, JEFFREY C (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:BEASOM
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 1:2706 REW CIR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4215
Mailing Address - Country:US
Mailing Address - Phone:407-614-8337
Mailing Address - Fax:407-614-8341
Practice Address - Street 1:2706 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4215
Practice Address - Country:US
Practice Address - Phone:407-614-8337
Practice Address - Fax:407-614-8341
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5738225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000698700Medicaid