Provider Demographics
NPI:1467623603
Name:BERNABE, ERIC ROSARIO (RPT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ROSARIO
Last Name:BERNABE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 ROSEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6729
Mailing Address - Country:US
Mailing Address - Phone:678-570-6093
Mailing Address - Fax:
Practice Address - Street 1:463 ROSEWOOD LN
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6729
Practice Address - Country:US
Practice Address - Phone:678-570-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-16
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCP008424T225100000X
GAPT005002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist