Provider Demographics
NPI:1326547712
Name:BERTRAND, MARIE-JOSEE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:MARIE-JOSEE
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 PIERRE DE-COUBERTIN
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:QC
Mailing Address - Zip Code:137
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4553 PIERRE DE-COUBERTIN
Practice Address - Street 2:
Practice Address - City:MONTREAL
Practice Address - State:QC
Practice Address - Zip Code:H1V3N7
Practice Address - Country:CA
Practice Address - Phone:514-259-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000215A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer