Healthcare Provider Details

I. General information

NPI: 1710284591
Provider Name (Legal Business Name): ANNE MARIE BERNADT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 S 16TH ST
LINCOLN NE
68502-3704
US

IV. Provider business mailing address

2300 S 16TH ST
LINCOLN NE
68502
US

V. Phone/Fax

Practice location:
  • Phone: 402-475-1011
  • Fax:
Mailing address:
  • Phone: 402-217-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number985
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: