Provider Demographics
NPI:1497086383
Name:THOMPSON, BERNADETTE DIANA (RRT)
Entity Type:Individual
Prefix:MRS
First Name:BERNADETTE
Middle Name:DIANA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 SAN MARINO RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-3332
Mailing Address - Country:US
Mailing Address - Phone:321-720-2790
Mailing Address - Fax:
Practice Address - Street 1:279 SAN MARINO RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-3332
Practice Address - Country:US
Practice Address - Phone:321-720-2790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT1940227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885208100Medicaid