Provider Demographics
NPI:1831717438
Name:BEARDT, BRADLEY (DPT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:BEARDT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 SHERIDAN LAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-5395
Mailing Address - Country:US
Mailing Address - Phone:605-721-3307
Mailing Address - Fax:605-721-3308
Practice Address - Street 1:3808 SHERIDAN LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-5395
Practice Address - Country:US
Practice Address - Phone:605-721-3307
Practice Address - Fax:605-721-3308
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist