Provider Demographics
NPI:1346620051
Name:PODWIKA, BERNADETTE (DPT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:PODWIKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 NW PROFESSIONAL DR
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3888
Mailing Address - Country:US
Mailing Address - Phone:541-752-0545
Mailing Address - Fax:541-757-0545
Practice Address - Street 1:2101 NW PROFESSIONAL DR
Practice Address - Street 2:SUITE #2
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3888
Practice Address - Country:US
Practice Address - Phone:541-752-0545
Practice Address - Fax:541-757-0545
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist