Provider Demographics
NPI:1639667926
Name:BEATTY, DOROTHY ANNE (PT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ANNE
Last Name:BEATTY
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 1:118 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GREENPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11944-1319
Mailing Address - Country:US
Mailing Address - Phone:814-574-5437
Mailing Address - Fax:
Practice Address - Street 1:118 BROAD ST
Practice Address - Street 2:
Practice Address - City:GREENPORT
Practice Address - State:NY
Practice Address - Zip Code:11944-1319
Practice Address - Country:US
Practice Address - Phone:814-574-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0416991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist