Provider Demographics
NPI:1215252671
Name:BEATY, MATTHEW JASON (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JASON
Last Name:BEATY
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Gender:M
Credentials:DPT
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Mailing Address - Street 1:4820 LINCOLN BLVD
Mailing Address - Street 2:STE C
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6917
Mailing Address - Country:US
Mailing Address - Phone:310-822-0041
Mailing Address - Fax:310-822-0049
Practice Address - Street 1:9830 PROSPECT AVE
Practice Address - Street 2:STE A
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4375
Practice Address - Country:US
Practice Address - Phone:619-448-4860
Practice Address - Fax:619-448-1639
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2017-01-13
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Provider Licenses
StateLicense IDTaxonomies
CA36046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist