Provider Demographics
NPI:1336693175
Name:BANSIL, BERNARD
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:BANSIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 132ND ST SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8999
Mailing Address - Country:US
Mailing Address - Phone:425-316-8046
Mailing Address - Fax:425-338-9637
Practice Address - Street 1:2000 HEWITT AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3600
Practice Address - Country:US
Practice Address - Phone:425-252-3908
Practice Address - Fax:425-252-7940
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60663279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist