MEDICARE: SUSAN R KABEARY 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	PT00000970	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00268495	OTHER	WA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7734482	OTHER	WA	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	192085	OTHER	WA	DEPT OF L&I
4	8939558	OTHER	WA	CRIME VICTIMS
6	3824KA	OTHER	WA	REGENCE BS

General Provider Information

NPI Number	:	1649262304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN R KABEARY PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	11019 CANYON RD E
Second Line	:	STE C
City	:	PUYALLUP
State	:	WA
Zip	:	98373-3001
Country	:	US
Telephone Number	:	253-286-3600
Fax Number	:	253-286-3444

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/10/2015

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Directions to “ SUSAN R KABEARY PT” Practice Location

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