Provider Demographics
NPI:1386639953
Name:BERTRAND, SHEILA MAE (PT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MAE
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 PLUMAS ST
Mailing Address - Street 2:STE 4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509
Mailing Address - Country:US
Mailing Address - Phone:775-826-2444
Mailing Address - Fax:775-826-9669
Practice Address - Street 1:1875 PLUMAS ST
Practice Address - Street 2:STE 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-826-2444
Practice Address - Fax:775-826-9669
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV339225100000X
CA15936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13679OtherNV CARE
S28104Medicare UPIN
36792Medicare ID - Type Unspecified