Provider Demographics
NPI:1073676128
Name:BEATTY, DONALD CRAIG (LMP)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CRAIG
Last Name:BEATTY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 S WISHKAH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520
Mailing Address - Country:US
Mailing Address - Phone:360-533-7960
Mailing Address - Fax:360-533-7966
Practice Address - Street 1:1314 S WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520
Practice Address - Country:US
Practice Address - Phone:360-533-7960
Practice Address - Fax:360-533-7966
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0004892225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist