Provider Demographics
NPI:1992505085
Name:BEYER, JESSICA-RAE (LMT)
Entity type:Individual
Prefix:
First Name:JESSICA-RAE
Middle Name:
Last Name:BEYER
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CHANCELLOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-2047
Mailing Address - Country:US
Mailing Address - Phone:609-665-1313
Mailing Address - Fax:
Practice Address - Street 1:4450 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3111
Practice Address - Country:US
Practice Address - Phone:609-829-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01170100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist