Provider Demographics
NPI:1649262304
Name:KABEARY, SUSAN R (PT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:KABEARY
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 1:790 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:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:11019 CANYON RD E
Practice Address - Street 2:STE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3001
Practice Address - Country:US
Practice Address - Phone:253-286-3600
Practice Address - Fax:253-286-3444
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7734482OtherAETNA
WA8368995Medicaid
WA192085OtherDEPT OF L&I
WA8939558OtherCRIME VICTIMS
WAP00268495OtherMEDICARE RAILROAD
WA3824KAOtherREGENCE BS
WA8368995Medicaid