Provider Demographics
NPI:1477961498
Name:BEATY, CHRISTIAN ANDREW (PTA)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANDREW
Last Name:BEATY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 ALABAMA ST
Mailing Address - Street 2:123
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-4553
Mailing Address - Country:US
Mailing Address - Phone:360-306-7274
Mailing Address - Fax:
Practice Address - Street 1:316 E MCLEOD RD STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6491
Practice Address - Country:US
Practice Address - Phone:360-734-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP161417887225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant