Provider Demographics
NPI:1013099613
Name:BEATTY, GARY RAY (AT,C)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RAY
Last Name:BEATTY
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 WATSON BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5130
Mailing Address - Country:US
Mailing Address - Phone:615-790-8255
Mailing Address - Fax:
Practice Address - Street 1:211 BEDFORD WAY
Practice Address - Street 2:STAR PYHSICAL THEREPY
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064
Practice Address - Country:US
Practice Address - Phone:615-591-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer