Provider Demographics
NPI:1922051838
Name:MOONEY, BERNARD PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:PATRICK
Last Name:MOONEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1002
Mailing Address - Country:US
Mailing Address - Phone:410-228-6049
Mailing Address - Fax:
Practice Address - Street 1:42 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1002
Practice Address - Country:US
Practice Address - Phone:410-228-6049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD12350OtherPHYSICAL THERAPY LICENSE