Provider Demographics
NPI:1801971742
Name:BEASLEY, JERRILYN JUNE
Entity type:Individual
Prefix:
First Name:JERRILYN
Middle Name:JUNE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4294 PINEHURST CIR
Mailing Address - Street 2:C2
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8368
Mailing Address - Country:US
Mailing Address - Phone:843-455-3698
Mailing Address - Fax:
Practice Address - Street 1:4237 RIVER HILLS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6444
Practice Address - Country:US
Practice Address - Phone:843-249-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC256225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant