Provider Demographics
NPI:1154931871
Name:BEUTEL, GARRETT
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:BEUTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 CANYON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1833
Mailing Address - Country:US
Mailing Address - Phone:214-763-1183
Mailing Address - Fax:
Practice Address - Street 1:4120 HERITAGE TRACE PKWY STE 220
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5309
Practice Address - Country:US
Practice Address - Phone:817-498-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist