Healthcare Provider Details

I. General information

NPI: 1134055262
Provider Name (Legal Business Name): HANNAH R BERNIER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E BROADWAY AVE STE 100
JACKSON WY
83001-8640
US

IV. Provider business mailing address

555 E BROADWAY AVE STE 100
JACKSON WY
83001-8640
US

V. Phone/Fax

Practice location:
  • Phone: 307-739-7491
  • Fax: 307-739-1831
Mailing address:
  • Phone: 307-739-7491
  • Fax: 307-739-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2615
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: