Provider Demographics
NPI:1962542480
Name:BARD, CONNE G (PT)
Entity type:Individual
Prefix:MRS
First Name:CONNE
Middle Name:G
Last Name:BARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1049 STRATTON PL
Mailing Address - Street 2:
Mailing Address - City:ELBERON
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-4573
Mailing Address - Country:US
Mailing Address - Phone:732-229-6192
Mailing Address - Fax:732-229-6192
Practice Address - Street 1:1049 STRATTON PL
Practice Address - Street 2:
Practice Address - City:ELBERON
Practice Address - State:NJ
Practice Address - Zip Code:07740-4573
Practice Address - Country:US
Practice Address - Phone:732-229-6192
Practice Address - Fax:732-229-6192
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist