Provider Demographics
NPI:1972726198
Name:BEATTY, DEBRA SUE (PT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:SUE
Last Name:BEATTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60127 412TH LN
Mailing Address - Street 2:
Mailing Address - City:NEW ULM
Mailing Address - State:MN
Mailing Address - Zip Code:56073-4222
Mailing Address - Country:US
Mailing Address - Phone:507-233-1348
Mailing Address - Fax:507-233-1247
Practice Address - Street 1:1324 5TH ST N
Practice Address - Street 2:NEW ULM MEDICAL CENTER
Practice Address - City:NEW ULM
Practice Address - State:MN
Practice Address - Zip Code:56073-1514
Practice Address - Country:US
Practice Address - Phone:507-233-1173
Practice Address - Fax:507-233-1247
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist