Provider Demographics
NPI:1720058837
Name:BERNARD, LEONARD P
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:P
Last Name:BERNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4149 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ONAWAY
Mailing Address - State:MI
Mailing Address - Zip Code:49765-8852
Mailing Address - Country:US
Mailing Address - Phone:989-733-9728
Mailing Address - Fax:989-733-9769
Practice Address - Street 1:4149 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765-8852
Practice Address - Country:US
Practice Address - Phone:989-733-9728
Practice Address - Fax:989-733-9769
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P65964Medicare UPIN
ON87920Medicare ID - Type Unspecified