Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 33373 | CA |
N | 2251N0400X | Physical Therapist - Neurology | 33373 | CA |
N | 2251P0200X | Physical Therapist - Pediatrics | 33373 | CA |
N | 225400000X | Rehabilitation Practitioner | 33373 | CA |
NPI | 1720062813 |
---|---|
Provider Name | Dr. Marybeth Grant-Beuttler |
First Address | Corona Del Mar, CA 92625-1437 |
Second Address | Corona Del Mar, CA 92625-1437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 12/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163623 | MEDPLUS (01) | PA |
3742484 | AETNA HMO (01) | PW |
7780635 | AETNA PPO (01) | PA |
819328 | FIRST PRIORITY/BC/BS (01) | PA |
9384434 | PHCS (01) | PA |
BE1698593 | HIGHMARK (01) | PA |