Provider Demographics
NPI:1013139146
Name:BEATY, JOHN J (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:BEATY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:1808 W BELTLINE HWY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:608-250-1497
Mailing Address - Fax:608-250-1384
Practice Address - Street 1:1300 S CENTURY AVE
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-2386
Practice Address - Country:US
Practice Address - Phone:608-849-4315
Practice Address - Fax:608-850-1606
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13230-24225100000X
NE596225100000X
WI10075-0242251G0304X
WI10075225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40436700Medicaid