Provider Demographics
NPI:1164578217
Name:BARDILAS, LIEZL Y (PT)
Entity Type:Individual
Prefix:MRS
First Name:LIEZL
Middle Name:Y
Last Name:BARDILAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 W. LACEY BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230
Mailing Address - Country:US
Mailing Address - Phone:877-360-8346
Mailing Address - Fax:877-360-8346
Practice Address - Street 1:1524 W. LACEY BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:877-360-8346
Practice Address - Fax:877-360-8346
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111222251X0800X
NY0168832251P0200X
CA340602251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic