Basic Information
| Provider Information | |||||||||
| NPI: | 1720306749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEERMAN | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | YEO | ||||||||
| OtherFirstName: | JULIE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 DENNIS ST SW STE B | ||||||||
| Address2: | |||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985016523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603380181 | ||||||||
| FaxNumber: | 3603380257 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 N NORTHWOOD CENTER CT STE B | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838144944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086657055 | ||||||||
| FaxNumber: | 5094664407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2010 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60139432 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1720306749 | 05 | WA | MEDICAID | P00937208 | 01 | WA | RR MEDICARE | OTHER |