Provider Demographics
NPI:1245607639
Name:BEATY, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BEATY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1556
Mailing Address - Country:US
Mailing Address - Phone:480-941-4169
Mailing Address - Fax:480-782-5213
Practice Address - Street 1:1805 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-1556
Practice Address - Country:US
Practice Address - Phone:480-941-4169
Practice Address - Fax:480-782-5213
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist