=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508948365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST ASHEVILLE PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 10/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 136 MIMOSA DR
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-258-2025
-----------------------------------------------------
Fax | 828-258-2026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136 MIMOSA DR
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-1719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-258-2025
-----------------------------------------------------
Fax | 828-258-2026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | SUZANNE MAUGER BERNARDI
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 828-258-2025
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 8800
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------