Basic Information
Provider Information
NPI: 1124756127
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERNHARDT
FirstName: STEPHANIE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14287 N 87TH ST STE 220
Address2:  
City: SCOTTSDALE
State: AZ
PostalCode: 852603698
CountryCode: US
TelephoneNumber: 4809371000
FaxNumber: 4808600356
Practice Location
Address1: 15800 N LITCHFIELD RD STE 130
Address2:  
City: SURPRISE
State: AZ
PostalCode: 853745516
CountryCode: US
TelephoneNumber: 6234009000
FaxNumber: 6234009001
Other Information
ProviderEnumerationDate: 08/09/2022
LastUpdateDate: 08/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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