MEDICARE: DR. ALEXANDER BERNARD DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	09619	LA

General Provider Information

NPI Number	:	1912595422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER BERNARD DPT

Provider Business Mailing Address
First Line	:	15717 BELLE DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1439
Country	:	US
Telephone Number	:	985-340-5998
Fax Number	:

Provider Business Practice Location Address
First Line	:	15717 BELLE DR
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1439
Country	:	US
Telephone Number	:	985-340-5998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2021
Last Update Date	:	11/08/2021

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