Provider Demographics
NPI:1295039808
Name:POTRATZ, BERNADETTE R (LMT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:R
Last Name:POTRATZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:R
Other - Last Name:POTRATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:(LMT)LICENSE MASSAGE
Mailing Address - Street 1:160 BENMONT AVE.
Mailing Address - Street 2:SUITE 23
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201
Mailing Address - Country:US
Mailing Address - Phone:802-681-6400
Mailing Address - Fax:
Practice Address - Street 1:160 BENMONT AVE.
Practice Address - Street 2:SUITE 23
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201
Practice Address - Country:US
Practice Address - Phone:802-681-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013908-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist