1336355353 NPI number — MRS. S. RENEA BEDARD M.P.T.

Table of content: MRS. S. RENEA BEDARD M.P.T. (NPI 1336355353)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336355353 NPI number — MRS. S. RENEA BEDARD M.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEDARD
Provider First Name:
S.
Provider Middle Name:
RENEA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336355353
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 SOUTHPOINTE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655-6141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-584-3914
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 MORGANTON BLVD SW
Provider Second Line Business Practice Location Address:
QUEST 4 LIFE REHAB
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-5669
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-757-6226
Provider Business Practice Location Address Fax Number:
828-757-6289
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8270 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 136KO . This is a "BCBS OF NC ID NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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