Provider Demographics
NPI:1417753344
Name:BERNARD, JAISLIE OLIVIA (PTA)
Entity type:Individual
Prefix:
First Name:JAISLIE
Middle Name:OLIVIA
Last Name:BERNARD
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:JAISLIE
Other - Middle Name:
Other - Last Name:SHEAFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 OLD TROLLEY RD STE D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5685
Mailing Address - Country:US
Mailing Address - Phone:843-871-3522
Mailing Address - Fax:843-871-3523
Practice Address - Street 1:440 OLD TROLLEY RD STE D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5685
Practice Address - Country:US
Practice Address - Phone:843-871-3522
Practice Address - Fax:843-871-3523
Is Sole Proprietor?:No
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant