Provider Demographics
NPI:1154432268
Name:BEDARD, STEPHANIE A (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:BEDARD
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:
Mailing Address - Fax:
Practice Address - Street 1:137 W HIGH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-8600
Practice Address - Country:US
Practice Address - Phone:410-392-7027
Practice Address - Fax:410-392-5768
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002114225100000X
MD18724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00692856OtherRAILROAD MEDICARE
DEAC44-0051OtherCAREFIRST
DE1154432268OtherDPCI
DE2519964OtherHIGHMARK
DE3763407000OtherIBC
MD2449072Medicaid
DE1154432268Medicaid
DE141052ZB82Medicare PIN