Provider Demographics
NPI:1710927124
Name:BERNARDI, SUZANNE MAUGER (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MAUGER
Last Name:BERNARDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6687
Mailing Address - Country:US
Mailing Address - Phone:828-734-9163
Mailing Address - Fax:828-456-1094
Practice Address - Street 1:490 HOSPITAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8026
Practice Address - Country:US
Practice Address - Phone:828-452-9477
Practice Address - Fax:828-452-9499
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC270085061OtherTRICARE
NC078VROtherBLUE CROSS/BLUE SHEILD
NC184220OtherMEDCOST
NC184220OtherMEDCOST