Provider Demographics
NPI:1275992877
Name:BERNARD, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 DARBY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1481
Mailing Address - Country:US
Mailing Address - Phone:610-647-1729
Mailing Address - Fax:610-647-1728
Practice Address - Street 1:40 DARBY RD STE 1
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-647-1729
Practice Address - Fax:610-647-1728
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60622615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01687406OtherRR MEDICARE
WA1275992877Medicaid
WAP01687406OtherRR MEDICARE