Provider Demographics
NPI:1639560352
Name:BEALE, JEFFERY (LMT)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:BEALE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 SW MUELLER DR
Mailing Address - Street 2:#D304
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97078-2506
Mailing Address - Country:US
Mailing Address - Phone:503-954-9176
Mailing Address - Fax:
Practice Address - Street 1:4650 SW MUELLER DR
Practice Address - Street 2:#D304
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97078-2506
Practice Address - Country:US
Practice Address - Phone:503-954-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19957172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist