Basic Information
| Provider Information | |||||||||
| NPI: | 1780827584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEELER | ||||||||
| FirstName: | JEROME | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2851 N TENAYA WAY STE 205 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026553456 | ||||||||
| FaxNumber: | 7026559594 | ||||||||
| Practice Location | |||||||||
| Address1: | 7455 W WASHINGTON AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891284338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026559456 | ||||||||
| FaxNumber: | 7022431830 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2009 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2274 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.