Provider Demographics
NPI:1861547440
Name:BEATTIE, CATHERINE WALL (PT)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:WALL
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 HOODS FORT CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3810
Mailing Address - Country:US
Mailing Address - Phone:678-354-4319
Mailing Address - Fax:
Practice Address - Street 1:3672 MARATHON CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1143
Practice Address - Country:US
Practice Address - Phone:678-945-8525
Practice Address - Fax:770-941-8647
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0089432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic