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General NPI Number Information
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NPI Number | 1699955286
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Entity Type | Individual
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Provider Name | MICHAEL LYNN BERNARDE PTA
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Gender | Male
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 1351 WISCONSIN RIVER DR
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City | PORT EDWARDS
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State | WI
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Zip | 54469-1041
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Country | US
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Telephone | 715-885-8300
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Fax | 715-885-8350
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Provider Business Mailing Address
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Address Line | 550 AIRPORT AVE
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-6514
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Country | US
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Telephone | 715-424-5331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 943-019
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License Number State | WI
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