Provider Demographics
NPI:1093340028
Name:BEATTY, DANIELLE JEANETTE (PTA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:JEANETTE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FAIRVIEW AVE N # 702
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4412
Mailing Address - Country:US
Mailing Address - Phone:707-307-3579
Mailing Address - Fax:
Practice Address - Street 1:116 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5360
Practice Address - Country:US
Practice Address - Phone:206-254-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP161027605225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant