Provider Demographics
NPI:1164465431
Name:GERVASI, BERNADETTE C (PT)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:C
Last Name:GERVASI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 N PECOS RD
Mailing Address - Street 2:B
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7345
Mailing Address - Country:US
Mailing Address - Phone:702-990-4123
Mailing Address - Fax:702-990-4125
Practice Address - Street 1:68 N PECOS RD
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7339
Practice Address - Country:US
Practice Address - Phone:702-990-4123
Practice Address - Fax:702-990-4125
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402119Medicaid
NV003402119Medicaid