Provider Demographics
NPI:1558846790
Name:BERNHARD, MIRIAM (LAC, MMP, LMT)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:BERNHARD
Suffix:
Gender:F
Credentials:LAC, MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PINE RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-9483
Mailing Address - Country:US
Mailing Address - Phone:828-707-7660
Mailing Address - Fax:
Practice Address - Street 1:27 PINE RIDGE TRL
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-9483
Practice Address - Country:US
Practice Address - Phone:828-707-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty