Healthcare Provider Details

I. General information

NPI: 1124388640
Provider Name (Legal Business Name): ANICK BERNIER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 HUTTLESTON AVE
FAIRHAVEN MA
02719-1605
US

IV. Provider business mailing address

270 HUTTLESTON AVE
FAIRHAVEN MA
02719-1605
US

V. Phone/Fax

Practice location:
  • Phone: 508-997-9100
  • Fax: 508-993-5854
Mailing address:
  • Phone: 508-997-9100
  • Fax: 508-993-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19983
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: