Provider Demographics
NPI:1609080514
Name:BEATTY, ANISIA (PT)
Entity Type:Individual
Prefix:
First Name:ANISIA
Middle Name:
Last Name:BEATTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANISIA
Other - Middle Name:TAUNYA
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:485 BURBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-8720
Mailing Address - Country:US
Mailing Address - Phone:717-885-3026
Mailing Address - Fax:
Practice Address - Street 1:485 BURBERRY LN
Practice Address - Street 2:
Practice Address - City:MOUNT WOLF
Practice Address - State:PA
Practice Address - Zip Code:17347-8720
Practice Address - Country:US
Practice Address - Phone:717-885-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19837225100000X
PA18327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist