Provider Demographics
NPI:1417942079
Name:BERTRAND, TIMOTHY JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:BERTRAND
Suffix:
Gender:M
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:89509-3321
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:89509-3321
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:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV340225100000X
CACA15893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV21109OtherNVCARE
R09777Medicare UPIN
30580392AMedicare ID - Type Unspecified