Provider Demographics
NPI:1225523426
Name:BERNARD, DEIDRE MARIE (PT, ATC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:MARIE
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MIRABEAU ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-1617
Mailing Address - Country:US
Mailing Address - Phone:937-981-9284
Mailing Address - Fax:937-981-9442
Practice Address - Street 1:550 MIRABEAU ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123-1617
Practice Address - Country:US
Practice Address - Phone:937-981-9284
Practice Address - Fax:937-981-9442
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7552255A2300X
OH8922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer