Provider Demographics
NPI:1558563460
Name:BEATTY, DONALD R (LMT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:BEATTY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531 SW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3305
Mailing Address - Country:US
Mailing Address - Phone:503-330-8632
Mailing Address - Fax:
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD
Practice Address - Street 2:SUITE 193
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2027
Practice Address - Country:US
Practice Address - Phone:503-330-8632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10951225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist