Provider Demographics
NPI:1619959392
Name:JAROS, BERNADETTE (PT)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:JAROS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:GOMOKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MS
Mailing Address - Street 1:135 AUTHORS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2606
Mailing Address - Country:US
Mailing Address - Phone:978-369-0342
Mailing Address - Fax:978-369-7687
Practice Address - Street 1:135 AUTHORS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2606
Practice Address - Country:US
Practice Address - Phone:978-369-0342
Practice Address - Fax:978-369-7687
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJAY69465Medicare UPIN