Provider Demographics
NPI:1770892325
Name:BEATON ORTHOPEDIC PHYSICAL THERAPY
Entity type:Organization
Organization Name:BEATON ORTHOPEDIC PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:STEVENS
Authorized Official - Last Name:BEATON
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS
Authorized Official - Phone:310-456-9332
Mailing Address - Street 1:24955 PACIFIC COAST HIGHWAY C-102
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:310-456-9332
Mailing Address - Fax:310-456-5868
Practice Address - Street 1:24955 PACIFIC COAST HWY STE C102
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4749
Practice Address - Country:US
Practice Address - Phone:310-456-9332
Practice Address - Fax:310-456-5868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MALIBU REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-30
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14525273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit