Provider Demographics
NPI:1649012162
Name:BERTRAND, MARK (DPT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 AVENIDA FELICIANO
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-1033
Mailing Address - Country:US
Mailing Address - Phone:562-208-8847
Mailing Address - Fax:
Practice Address - Street 1:2068 AVENIDA FELICIANO
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-1033
Practice Address - Country:US
Practice Address - Phone:562-208-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist