MEDICARE: GLEN V BEATO 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	PT28282	CA

General Provider Information

NPI Number	:	1265557334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN V BEATO P.T.

Provider Business Mailing Address
First Line	:	320 BROADWAY STE 2
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-3502
Country	:	US
Telephone Number	:	619-422-0404
Fax Number	:	619-422-4153

Provider Business Practice Location Address
First Line	:	181 JAMACHA ROAD
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92019-0000
Country	:	US
Telephone Number	:	619-447-7774
Fax Number	:	619-447-7779

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	03/17/2018

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Directions to “ GLEN V BEATO P.T.” Practice Location

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