Provider Demographics
NPI:1851763684
Name:BERTRAND, LOUIS (PTA)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2254
Mailing Address - Country:US
Mailing Address - Phone:252-443-9103
Mailing Address - Fax:252-451-9032
Practice Address - Street 1:7277 NC HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-7527
Practice Address - Country:US
Practice Address - Phone:919-773-4086
Practice Address - Fax:919-773-4087
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 26043225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant