MEDICARE: DEREK BEADLE

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	PT-5933	MT

General Provider Information

NPI Number	:	1164849105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK BEADLE

Provider Business Mailing Address
First Line	:	1225 PERRY LN
Second Line	:
City	:	GLASGOW
State	:	MT
Zip	:	59230-1532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 PERRY LN
Second Line	:
City	:	GLASGOW
State	:	MT
Zip	:	59230-1532
Country	:	US
Telephone Number	:	406-228-2461
Fax Number	:

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

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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