Provider Demographics
NPI:1306276829
Name:BEDARD, ANN COMPO (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:COMPO
Last Name:BEDARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:COMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1635 OHIO ST.
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601
Mailing Address - Country:US
Mailing Address - Phone:315-786-7285
Mailing Address - Fax:315-786-7270
Practice Address - Street 1:1635 OHIO ST.
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-786-7285
Practice Address - Fax:315-786-7270
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036672-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist