Provider Demographics
NPI:1043829096
Name:BERNIER, LANA L (PT,MPT)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:L
Last Name:BERNIER
Suffix:
Gender:F
Credentials:PT,MPT
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MPT
Mailing Address - Street 1:17045 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2754
Mailing Address - Country:US
Mailing Address - Phone:662-773-3700
Mailing Address - Fax:662-773-3765
Practice Address - Street 1:17045 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2754
Practice Address - Country:US
Practice Address - Phone:662-773-3700
Practice Address - Fax:662-773-3765
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT1164530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist