Provider Demographics
NPI:1164020590
Name:BERNAL, FELIXBERTO ENRIQUEZ (PT)
Entity Type:Individual
Prefix:MR
First Name:FELIXBERTO
Middle Name:ENRIQUEZ
Last Name:BERNAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3759 61ST ST STE M2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2590
Mailing Address - Country:US
Mailing Address - Phone:718-424-2273
Mailing Address - Fax:718-424-2278
Practice Address - Street 1:3759 61ST ST STE M2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2590
Practice Address - Country:US
Practice Address - Phone:718-424-2273
Practice Address - Fax:718-424-2278
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist