Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 10075 | WI |
N | 225100000X | Physical Therapist | 13230-24 | WI |
N | 225100000X | Physical Therapist | 596 | NE |
N | 2251G0304X | Physical Therapist - Geriatrics | 10075-024 | WI |
NPI | 1013139146 |
---|---|
Provider Name | Mr. John J Beaty |
First Address | Madison, WI 53713-2334 |
Second Address | Waunakee, WI 53597-2386 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 30/10/2020 |