Healthcare Provider Details

I. General information

NPI: 1497968085
Provider Name (Legal Business Name): LEQUITA BEATON M.S. ,ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PEMBERTON BROWNS MILLS RD
PEMBERTON NJ
08068-1536
US

IV. Provider business mailing address

78 CATHERINE DR
FRANKLINVILLE NJ
08322-2764
US

V. Phone/Fax

Practice location:
  • Phone: 609-894-9311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number25MT00132200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: