Provider Demographics
NPI:1801134267
Name:BERNARD, ROBERT WILLIS (LMP)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIS
Last Name:BERNARD
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16604 SE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-4210
Mailing Address - Country:US
Mailing Address - Phone:253-335-0135
Mailing Address - Fax:
Practice Address - Street 1:16604 SE 167TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-4210
Practice Address - Country:US
Practice Address - Phone:253-335-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022228225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist