Provider Demographics
NPI:1346224623
Name:BERNARD, JAIME (PT)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:BERNARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JAIME
Other - Middle Name:D
Other - Last Name:BERNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT MS
Mailing Address - Street 1:31 PILGRIM RD
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-2944
Mailing Address - Country:US
Mailing Address - Phone:781-258-2851
Mailing Address - Fax:
Practice Address - Street 1:31 PILGRIM RD
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-2944
Practice Address - Country:US
Practice Address - Phone:781-258-2851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68762Medicare PIN