Provider Demographics
NPI:1174011506
Name:JAVIER, BERNADETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:JAVIER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 COUNTRY MANOR WAY APT 9
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-3355
Mailing Address - Country:US
Mailing Address - Phone:518-727-4430
Mailing Address - Fax:
Practice Address - Street 1:700 COTTAGE BROOK LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8654
Practice Address - Country:US
Practice Address - Phone:518-727-4430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist