Provider Demographics
NPI:1245808872
Name:BEATTY, STEPHANIE NICOLE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICOLE
Last Name:BEATTY
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 1:7332 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2459
Mailing Address - Country:US
Mailing Address - Phone:301-741-3113
Mailing Address - Fax:
Practice Address - Street 1:8890 CENTRE PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2170
Practice Address - Country:US
Practice Address - Phone:410-884-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist