Basic Information
| Provider Information | |||||||||
| NPI: | 1154432268 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEDARD | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 PROFESSIONAL BUILDING | ||||||||
| Address2: | 1265 WAYNE AVENUE, SUITE 308 | ||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248018095 | ||||||||
| FaxNumber: | 7248018147 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 MULLET RUN | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199635373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024241810 | ||||||||
| FaxNumber: | 3024243092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0002114 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 18724 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1154432268 | 01 | DE | DPCI | OTHER | AC44-0051 | 01 | DE | CAREFIRST | OTHER | 3763407000 | 01 | DE | IBC | OTHER | 2449072 | 05 | MD | MEDICAID | 2519964 | 01 | DE | HIGHMARK | OTHER | 1154432268 | 05 | DE | MEDICAID | P00692856 | 01 | DE | RAILROAD MEDICARE | OTHER |