MEDICARE: GARRETT BEUTEL

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

General Provider Information

NPI Number	:	1154931871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARRETT BEUTEL

Provider Business Mailing Address
First Line	:	2803 CANYON VALLEY DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-1833
Country	:	US
Telephone Number	:	214-763-1183
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 HERITAGE TRACE PKWY STE 220
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5309
Country	:	US
Telephone Number	:	817-498-8585
Fax Number	:

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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Directions to “ GARRETT BEUTEL ” Practice Location

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