Provider Demographics
NPI:1154399681
Name:MCHUGH, BERNADETTE (MSPT)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:MCHUGH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:
Other - Last Name:NOONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:228 SPARROW BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5501
Mailing Address - Country:US
Mailing Address - Phone:561-629-3325
Mailing Address - Fax:
Practice Address - Street 1:150 FOUNTAINS WAY STE 4
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-1171
Practice Address - Country:US
Practice Address - Phone:904-825-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24294225100000X
MA17352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68539OtherBLUECROSS BLUESHIELD
MA000000033239OtherBOSTON MEDICAL CENTER HEALTHNET
MA487176OtherTUFTS
MA0704393Medicaid
524008OtherFALLON