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General NPI Number Information
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NPI Number | 1013337161
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Entity Type | Organization
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Legal Business Name | THE BERNSTEIN INSTITUTE FOR TRAUMA TREATMENT
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Dates
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Enumeration Date | 04/16/2014
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 501 2ND ST
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City | PETALUMA
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State | CA
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Zip | 94952-5121
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Country | US
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Telephone | 707-781-3335
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Fax | 707-762-8763
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Provider Business Mailing Address
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Address Line | 501 2ND ST
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City | PETALUMA
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State | CA
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Zip | 94952-5121
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Country | US
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Telephone | 707-781-3335
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Fax | 707-762-8763
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER MARK BERNSTEIN
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Credential | PHD
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Telephone | 707-781-3335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 633153
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MFT7549
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License Number State | CA
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