Provider Demographics
NPI:1225164403
Name:BERNABALE, TRACI - (PT)
Entity Type:Individual
Prefix:MISS
First Name:TRACI
Middle Name:-
Last Name:BERNABALE
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 1:35941 WESTMINISTER AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1372
Mailing Address - Country:US
Mailing Address - Phone:440-353-0400
Mailing Address - Fax:
Practice Address - Street 1:1997 HEALTHWAY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2834
Practice Address - Country:US
Practice Address - Phone:440-988-6890
Practice Address - Fax:440-988-6895
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05362225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist