Provider Demographics
NPI:1780827584
Name:BEELER, JEROME (DPT)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:BEELER
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 1:2851 N TENAYA WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0453
Mailing Address - Country:US
Mailing Address - Phone:702-655-3456
Mailing Address - Fax:702-655-9594
Practice Address - Street 1:7455 W WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4338
Practice Address - Country:US
Practice Address - Phone:702-655-9456
Practice Address - Fax:702-243-1830
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist