Provider Demographics
NPI:1770788127
Name:BEATY, JANE LASTER (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LASTER
Last Name:BEATY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2867
Mailing Address - Country:US
Mailing Address - Phone:706-494-3871
Mailing Address - Fax:
Practice Address - Street 1:6298 VETERANS PKWY
Practice Address - Street 2:SUITE 5A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6258
Practice Address - Country:US
Practice Address - Phone:706-320-5468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist