Provider Demographics
NPI:1770672883
Name:BEAN, WILLIAM BRADLEY (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:BEAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:29275 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1044
Practice Address - Country:US
Practice Address - Phone:248-351-6300
Practice Address - Fax:248-351-9329
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F329410OtherBLUE CROSS BLUE SHIELD
MI0Q26462034Medicare ID - Type Unspecified
MIMI6211127Medicare PIN