Provider Demographics
NPI:1265692255
Name:CROMPTON, BERNADETTE (DPT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:CROMPTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:MCINTYRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-3251
Practice Address - Street 1:266 EAGLEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1157
Practice Address - Country:US
Practice Address - Phone:610-524-1019
Practice Address - Fax:610-524-4125
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10002373225100000X
PAPT019883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1265692255Medicaid
3534246000OtherAMERIHEALTH IBC
1265692255OtherCHAMPUS TRICARE
5070-0105OtherGHMSI
94266201OtherCARE FIRST
DE1265692255Medicaid
94266201OtherCARE FIRST
3534246000OtherAMERIHEALTH IBC