Provider Demographics
NPI:1861472078
Name:BEAUDOIN, MICHAEL (DPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:BEAUDOIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3216
Mailing Address - Country:US
Mailing Address - Phone:215-742-8099
Mailing Address - Fax:215-742-1871
Practice Address - Street 1:2127 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3216
Practice Address - Country:US
Practice Address - Phone:215-742-8099
Practice Address - Fax:215-742-1871
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPTO12778L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1726303OtherBLUE SHIELD PC
PA45798OtherHEALTH PARTNERS
PAQ87414OtherAMERIHEALTH ADMIN
PA1687414OtherHIGHMARK BLUE SHIELD
PA50711OtherUS HEALTHCARE
PA2395652000OtherKEYSTONE HEALTH PLAN EAST
PA610675900OtherUS DEPT OF LABOR
PA2395652000OtherIBC
PA3839602OtherAETNA
PA2395652000OtherKEYSTONE 65
PA2395652000OtherAMERIHEALTH HMO
PA246902OtherHORIZON NJ PLUS
PA30023534OtherKEYSTONE MERCY
PA30023534OtherKEYSTONE MERCY