Provider Demographics
NPI:1346206026
Name:LOUGH, BERNARD JOSEPH (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:JOSEPH
Last Name:LOUGH
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:LOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:4301 BROADWAY ST
Mailing Address - Street 2:CPO 288
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6318
Mailing Address - Country:US
Mailing Address - Phone:210-283-6481
Mailing Address - Fax:
Practice Address - Street 1:4301 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6318
Practice Address - Country:US
Practice Address - Phone:210-829-3834
Practice Address - Fax:210-841-7324
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT28042255A2300X
OHAT12892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer