Bernadette Brase, P.T.

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT30174 Issued in CA

Practice address

6815 Noble Ave
Van Nuys, CA 91405-3796

Phone

(818) 901-6600

Fax

(818) 997-7826

NPI assigned

Mar 8, 2007

Last updated

Nov 7, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1316078736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 DRY CREEK DR",
            "address_2": "STE 200",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805036405",
            "telephone_number": "818-901-6600",
            "fax_number": "818-997-7826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6815 NOBLE AVE",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053796",
            "telephone_number": "818-901-6600",
            "fax_number": "818-997-7826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRASE",
        "first_name": "BERNADETTE",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-08",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0016293",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT30174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT30174",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Orthopedic Physical Therapist in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Orthopedic Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.