Healthcare Provider Details

I. General information

NPI: 1336194158
Provider Name (Legal Business Name): KERRY KATHLEEN SUAREZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY K BEARDSLEE M.P.T.

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N 1ST ST STE D
HERMISTON OR
97838-1682
US

IV. Provider business mailing address

PO BOX 90
SUNNYSIDE WA
98944-0090
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-5678
  • Fax: 541-567-2110
Mailing address:
  • Phone: 541-567-5678
  • Fax: 541-567-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number66275
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: