Provider Demographics
NPI:1013205962
Name:FLANERY, BERNADETTE SMITH (PTA)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:SMITH
Last Name:FLANERY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE SQUARE CENTER, SUITE A
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042
Mailing Address - Country:US
Mailing Address - Phone:314-731-4555
Mailing Address - Fax:314-551-6105
Practice Address - Street 1:1 VILLAGE SQUARE CTR
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1817
Practice Address - Country:US
Practice Address - Phone:314-731-4555
Practice Address - Fax:314-551-6110
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017814225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant