Provider Demographics
NPI:1336355353
Name:BEDARD, S. RENEA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:S.
Middle Name:RENEA
Last Name:BEDARD
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 1:1513 SOUTHPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-6141
Mailing Address - Country:US
Mailing Address - Phone:828-584-3914
Mailing Address - Fax:
Practice Address - Street 1:1031 MORGANTON BLVD SW
Practice Address - Street 2:QUEST 4 LIFE REHAB
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5669
Practice Address - Country:US
Practice Address - Phone:828-757-6226
Practice Address - Fax:828-757-6289
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136KOOtherBCBS OF NC ID NUMBER