Provider Demographics
NPI:1962705699
Name:BEUTEL, BRIAN JG (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JG
Last Name:BEUTEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 NICHOLAS STREET
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5113
Mailing Address - Country:US
Mailing Address - Phone:610-252-2216
Mailing Address - Fax:
Practice Address - Street 1:3615 NICHOLAS STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5113
Practice Address - Country:US
Practice Address - Phone:610-252-2216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206422225100000X
PAPT022782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist