Healthcare Provider Details

I. General information

NPI: 1588719314
Provider Name (Legal Business Name): CATHERINE MARION BERNARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MARION HARTLEY PT

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DEPOT RD
FALMOUTH ME
04105
US

IV. Provider business mailing address

50 DEPOT RD
FALMOUTH ME
04105
US

V. Phone/Fax

Practice location:
  • Phone: 208-781-8881
  • Fax: 207-781-8855
Mailing address:
  • Phone: 208-781-8881
  • Fax: 207-781-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT3251
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: