Provider Demographics
NPI:1861504565
Name:KROON, BERNADETTE MARIA (PT)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:MARIA
Last Name:KROON
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 1:344 PREBLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2236
Mailing Address - Country:US
Mailing Address - Phone:207-899-0171
Mailing Address - Fax:
Practice Address - Street 1:344 PREBLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2236
Practice Address - Country:US
Practice Address - Phone:207-899-0171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9217225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist