Provider Demographics
NPI:1639174089
Name:BEATY, KRISTIE ANN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ANN
Last Name:BEATY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S BEST AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088-1217
Mailing Address - Country:US
Mailing Address - Phone:610-760-1520
Mailing Address - Fax:610-760-1721
Practice Address - Street 1:1597 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3813
Practice Address - Country:US
Practice Address - Phone:610-791-4833
Practice Address - Fax:610-791-1633
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016487225100000X
NJ40QA01111500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101086272Medicaid
PA394529Medicare ID - Type Unspecified