Provider Demographics
NPI:1043658628
Name:BERNARD, ALAN J (LMP)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:J
Last Name:BERNARD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 PERRY LOOP
Mailing Address - Street 2:APT 1
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6152
Mailing Address - Country:US
Mailing Address - Phone:509-307-4256
Mailing Address - Fax:
Practice Address - Street 1:1508 PERRY LOOP
Practice Address - Street 2:APT 1
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6152
Practice Address - Country:US
Practice Address - Phone:509-307-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist