Provider Demographics
NPI:1093729907
Name:BERARDINELLI, RAYMOND A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:A
Last Name:BERARDINELLI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12848 DUNNINGS HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16625-8285
Mailing Address - Country:US
Mailing Address - Phone:814-884-8489
Mailing Address - Fax:
Practice Address - Street 1:12848 DUNNINGS HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CLAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16625-8285
Practice Address - Country:US
Practice Address - Phone:814-884-8489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019507680028Medicaid
PAQ28529Medicare UPIN