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General NPI Number Information
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NPI Number | 1023866423
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Entity Type | Individual
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Provider Name | BRANDON ELIJAH BEATTY
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Gender | Male
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Dates
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Enumeration Date | 05/09/2024
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 4980 BOILING BROOK PKWY
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City | NORTH BETHESDA
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State | MD
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Zip | 20852-2300
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Country | US
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Telephone | 240-541-5241
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Fax |
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Provider Business Mailing Address
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Address Line | 4704 25TH ST
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City | MOUNT RAINIER
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State | MD
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Zip | 20712-1228
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Country | US
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Telephone | 301-828-8416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 30325
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License Number State | MD
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