Provider Demographics
NPI:1740237395
Name:BEMIS, CALEB (PT)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:
Last Name:BEMIS
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 1:19 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3071
Mailing Address - Country:US
Mailing Address - Phone:706-267-8019
Mailing Address - Fax:
Practice Address - Street 1:15 JANE JACOBS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6306
Practice Address - Country:US
Practice Address - Phone:828-669-8643
Practice Address - Fax:828-669-8648
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007931225100000X
NC11388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ61365Medicare UPIN