Provider Demographics
NPI:1194715961
Name:BERNIER, RICHARD (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BERNIER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:J
Other - Last Name:BERNIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:37 1/2 FORRESTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1938
Mailing Address - Country:US
Mailing Address - Phone:978-465-2862
Mailing Address - Fax:978-465-2839
Practice Address - Street 1:37 1/2 FORRESTER ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1938
Practice Address - Country:US
Practice Address - Phone:978-465-2862
Practice Address - Fax:978-465-2839
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4096Medicare PIN
MAY65171Medicare PIN