Provider Demographics
NPI:1295446383
Name:BEADLE, KEVIN BLAKE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BLAKE
Last Name:BEADLE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:1485 E FLORENCE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4797
Practice Address - Country:US
Practice Address - Phone:520-494-3058
Practice Address - Fax:520-214-5059
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027038225100000X
AZLPT-32707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist