Provider Demographics
NPI:1902925191
Name:BERNARD, LAUREL B (PT, OCS, FAAOMPT)
Entity type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:B
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PT, OCS, FAAOMPT
Other - Prefix:MS
Other - First Name:LAUREL
Other - Middle Name:B
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, OCS, COMT
Mailing Address - Street 1:1600 MARY ELLEN ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-4142
Mailing Address - Country:US
Mailing Address - Phone:505-710-2640
Mailing Address - Fax:505-830-6505
Practice Address - Street 1:4930 MCLEOD RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2118
Practice Address - Country:US
Practice Address - Phone:505-830-3678
Practice Address - Fax:505-830-6505
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist