Provider Demographics
NPI:1497991376
Name:ROBERTS, BERNADETTE L (MPT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:L
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500-200TH ST SW
Mailing Address - Street 2:EDMONDS SCHOOL DISTRICT MAPLEWOOD CENTER
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6627
Mailing Address - Country:US
Mailing Address - Phone:425-431-3052
Mailing Address - Fax:425-431-7511
Practice Address - Street 1:8500-200TH ST SW
Practice Address - Street 2:MAPLEWOOD CENTER OT/PT
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6627
Practice Address - Country:US
Practice Address - Phone:425-431-3052
Practice Address - Fax:425-431-7511
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008583225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist