MEDICARE: MS. NANCY BEATY P,T,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05005000A	IN

General Provider Information

NPI Number	:	1316162563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY BEATY P,T,

Provider Business Mailing Address
First Line	:	2817 E 1150 S
Second Line	:
City	:	FLAT ROCK
State	:	IN
Zip	:	47234-9554
Country	:	US
Telephone Number	:	812-390-9760
Fax Number	:	765-525-5410

Provider Business Practice Location Address
First Line	:	2817 E 1150 S
Second Line	:
City	:	FLAT ROCK
State	:	IN
Zip	:	47234-9554
Country	:	US
Telephone Number	:	812-390-9760
Fax Number	:	765-525-5410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2007
Last Update Date	:	07/09/2007

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