Basic Information
| Provider Information | |||||||||
| NPI: | 1265692255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROMPTON | ||||||||
| FirstName: | BERNADETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCINTYRE | ||||||||
| OtherFirstName: | BERNADETTE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307593251 | ||||||||
| Practice Location | |||||||||
| Address1: | 266 EAGLEVIEW BLVD | ||||||||
| Address2: | |||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193411157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105241019 | ||||||||
| FaxNumber: | 6105244125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2008 | ||||||||
| LastUpdateDate: | 05/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J10002373 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT019883 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1265692255 | 05 | DE | MEDICAID | 3534246000 | 01 | AMERIHEALTH IBC | OTHER | 1265692255 | 01 | CHAMPUS TRICARE | OTHER | 5070-0105 | 01 | GHMSI | OTHER | 94266201 | 01 | CARE FIRST | OTHER |