Provider Demographics
NPI:1629134747
Name:BEADLE, KRISTIN SHIMP (DPT)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:SHIMP
Last Name:BEADLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7528 UPPER CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7038
Mailing Address - Country:US
Mailing Address - Phone:614-580-9737
Mailing Address - Fax:
Practice Address - Street 1:698 MORRISON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4419
Practice Address - Country:US
Practice Address - Phone:614-868-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2698317Medicaid
OHSH4093521-2Medicare ID - Type Unspecified