Healthcare Provider Details

I. General information

NPI: 1083239982
Provider Name (Legal Business Name): BEATTY HARRIS SPORTS MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3537 W CHESTER PIKE
NEWTOWN SQUARE PA
19073-3701
US

IV. Provider business mailing address

144 N. NARBERTH AVENUE P.O. BOX 305
NARBERTH PA
19072
US

V. Phone/Fax

Practice location:
  • Phone: 610-601-9177
  • Fax: 610-723-7772
Mailing address:
  • Phone: 610-601-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRICIA BEATTY
Title or Position: PROVIDER/AUTHORIZED REPRESENTATIVE
Credential: DO
Phone: 757-617-5181