Provider Demographics
NPI:1730672775
Name:BEATY, AMANDA FLOYD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:FLOYD
Last Name:BEATY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6613 KEYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-5209
Mailing Address - Country:US
Mailing Address - Phone:919-793-4840
Mailing Address - Fax:
Practice Address - Street 1:3000 ERWIN ROAD
Practice Address - Street 2:ROOM 153
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4504
Practice Address - Country:US
Practice Address - Phone:919-684-0875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist