Provider Demographics
NPI:1851635700
Name:BELADY, JOAN CECELIA (PT)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:CECELIA
Last Name:BELADY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:CECELIA
Other - Last Name:KEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7218 78TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5511
Mailing Address - Country:US
Mailing Address - Phone:206-708-6985
Mailing Address - Fax:206-708-6985
Practice Address - Street 1:25117 SW PARKWAY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9697
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60072491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist