Provider Demographics
NPI:1144396664
Name:BEATON ORTHOPEDIC PHYSICAL THERAPY-MALIBU REHABILITATION CENTER
Entity Type:Organization
Organization Name:BEATON ORTHOPEDIC PHYSICAL THERAPY-MALIBU REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEATON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:310-456-9332
Mailing Address - Street 1:24955 PACIFIC COAST HWY
Mailing Address - Street 2:C-102
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4700
Mailing Address - Country:US
Mailing Address - Phone:310-456-9332
Mailing Address - Fax:310-456-5868
Practice Address - Street 1:24955 PACIFIC COAST HWY
Practice Address - Street 2:C-102
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4700
Practice Address - Country:US
Practice Address - Phone:310-456-9332
Practice Address - Fax:310-456-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14928Medicare PIN