Provider Demographics
NPI:1467420430
Name:BERNHARDT, EDIE (PT)
Entity Type:Individual
Prefix:MS
First Name:EDIE
Middle Name:
Last Name:BERNHARDT
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 1:5 THRUSH LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05452-2239
Mailing Address - Country:US
Mailing Address - Phone:802-860-4360
Mailing Address - Fax:
Practice Address - Street 1:426 INDUSTRIAL AVE STE 190
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7904
Practice Address - Country:US
Practice Address - Phone:802-860-4360
Practice Address - Fax:802-488-3160
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0000825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT353382OtherMVP
VT5863801OtherVMC
VT1469336OtherCIGNA
VT2374OtherBCBS
VT1006858Medicaid
VTBEVN2592Medicare ID - Type Unspecified