Provider Demographics
NPI:1184790685
Name:BEATON, GREGORY S (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:S
Last Name:BEATON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24955 PACIFIC COAST HWY
Mailing Address - Street 2:C-102
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4700
Mailing Address - Country:US
Mailing Address - Phone:310-456-9332
Mailing Address - Fax:310-456-5868
Practice Address - Street 1:24955 PACIFIC COAST HWY
Practice Address - Street 2:C-102
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4700
Practice Address - Country:US
Practice Address - Phone:310-456-9332
Practice Address - Fax:310-456-5868
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT141582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14928Medicare ID - Type Unspecified