MEDICARE: SUSAN M BEARDEMPHL PT

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	PT00005235	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650015277	OTHER	WA	R/R MED
2	8930871	OTHER	WA	CRIME VICTIMS
3	118317	OTHER	WA	DEPT OF L&I
4	3822BE	OTHER	WA	REGENCE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093708950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M BEARDEMPHL PT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10004 204TH AVE E
Second Line	:	STE 3100
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-6539
Country	:	US
Telephone Number	:	253-863-7510
Fax Number	:	253-863-5970

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

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	08/05/2025

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