Basic Information
| Provider Information | |||||||||
| NPI: | 1083239982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEATTY HARRIS SPORTS MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144 N. NARBERTH AVENUE | ||||||||
| Address2: | P.O. BOX 305 | ||||||||
| City: | NARBERTH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106019177 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3537 W CHESTER PIKE | ||||||||
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| City: | NEWTOWN SQUARE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190733701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106019177 | ||||||||
| FaxNumber: | 6107237772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2020 | ||||||||
| LastUpdateDate: | 07/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEATTY | ||||||||
| AuthorizedOfficialFirstName: | TRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER/AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 7576175181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 07/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.