Provider Demographics
NPI:1851541940
Name:BERNARD, NINA ELIZABETH (MPT)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:ELIZABETH
Last Name:BERNARD
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 1:2986 W OAKHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-1916
Mailing Address - Country:US
Mailing Address - Phone:417-883-0838
Mailing Address - Fax:
Practice Address - Street 1:2986 W OAKHAVEN LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-1916
Practice Address - Country:US
Practice Address - Phone:417-883-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist