=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629707013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NELLA BERNARDONI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2022
-----------------------------------------------------
Last Update Date | 06/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 CLAY ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53530-1228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-776-4466
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12361 RIVER END RD
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53530-9618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-482-1521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 13144-24
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------