Provider Demographics
NPI:1306375100
Name:BERNARD, TYLER (MS, LAT, ATC, CES)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BERNARD
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10611 LYNX RANGE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4021
Mailing Address - Country:US
Mailing Address - Phone:719-641-9788
Mailing Address - Fax:
Practice Address - Street 1:1 UTSA CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1644
Practice Address - Country:US
Practice Address - Phone:719-641-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT70252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer