Provider Demographics
NPI:1154387686
Name:BEATY, JONATHAN ANDREW (ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ANDREW
Last Name:BEATY
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 ASH ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4120
Mailing Address - Country:US
Mailing Address - Phone:630-618-9310
Mailing Address - Fax:
Practice Address - Street 1:4334 FOX VALLEY CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7945
Practice Address - Country:US
Practice Address - Phone:630-618-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer