Provider Demographics
NPI:1629313762
Name:BOLADAS, BEVERLY (PT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:BOLADAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CHICORY DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1809
Mailing Address - Country:US
Mailing Address - Phone:302-253-8074
Mailing Address - Fax:302-644-7062
Practice Address - Street 1:17026 CADBURY CIR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-7022
Practice Address - Country:US
Practice Address - Phone:302-644-6390
Practice Address - Fax:302-644-7062
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist