Provider Demographics
NPI:1114207305
Name:BEATTY, KATHERINE M (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:BEATTY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 KINSTON HWY
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-6271
Mailing Address - Country:US
Mailing Address - Phone:910-389-6749
Mailing Address - Fax:
Practice Address - Street 1:624 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:HOLLY RIDGE
Practice Address - State:NC
Practice Address - Zip Code:28445-8660
Practice Address - Country:US
Practice Address - Phone:910-389-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0327712251P0200X
NCP138422251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics