Provider Demographics
NPI:1528490232
Name:MIKLOS, BERNARD JOHNATHAN JR (DPT)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:JOHNATHAN
Last Name:MIKLOS
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2160
Mailing Address - Country:US
Mailing Address - Phone:717-242-4840
Mailing Address - Fax:717-242-4841
Practice Address - Street 1:224 N LOGAN BLVD STE 230
Practice Address - Street 2:
Practice Address - City:BURNHAM
Practice Address - State:PA
Practice Address - Zip Code:17009-1850
Practice Address - Country:US
Practice Address - Phone:717-803-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022937225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist