Provider Demographics
NPI:1851634893
Name:BEERY'S PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:BEERY'S PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-966-2251
Mailing Address - Street 1:PO BOX 5008-190
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-5008
Mailing Address - Country:US
Mailing Address - Phone:209-966-2251
Mailing Address - Fax:209-966-2771
Practice Address - Street 1:5008 HIGHWAY 140 UNIT B
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-2434
Practice Address - Country:US
Practice Address - Phone:209-966-2251
Practice Address - Fax:209-966-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32428261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHD825AMedicare PIN