Provider Demographics
NPI:1427028422
Name:BEAUPAIN, ANGELA DAWN (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:BEAUPAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:MELLEMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:420 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4637
Mailing Address - Country:US
Mailing Address - Phone:360-714-0870
Mailing Address - Fax:360-714-0872
Practice Address - Street 1:1204 RAILROAD AVE STE 101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5068
Practice Address - Country:US
Practice Address - Phone:360-714-0870
Practice Address - Fax:360-714-0872
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5359MEOtherREGENCE BS
WA0171222OtherLABOR AND INDUSTRY
WA8335796Medicaid
A011OtherTRICARE
P00011498OtherRR MEDICARE
WA0171222OtherLABOR AND INDUSTRY
WA5359MEOtherREGENCE BS