Provider Demographics
NPI:1699323436
Name:BEATY, BRENDA L (LMT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:BEATY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5391
Mailing Address - Country:US
Mailing Address - Phone:907-339-8784
Mailing Address - Fax:907-339-8786
Practice Address - Street 1:1825 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5391
Practice Address - Country:US
Practice Address - Phone:907-339-8784
Practice Address - Fax:907-339-8786
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist