Healthcare Provider Details

I. General information

NPI: 1780838532
Provider Name (Legal Business Name): JAN R BERNARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 CENTRAL AVE STE A
ASHEVILLE NC
28801
US

IV. Provider business mailing address

77 CENTRAL AVE STE A
ASHEVILLE NC
28801-2452
US

V. Phone/Fax

Practice location:
  • Phone: 828-505-4886
  • Fax:
Mailing address:
  • Phone: 828-505-4886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number11861
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: