Doctor Name: | MR. SHAD THEODORE BERNARD |
NPI Number: | 1902873268 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, ATC/L |
License Number: | AT-001528 |
Business Practice Address: | 1997 Miamisburg Centerville Rd Dayton, OH - 454593811 |
Business Phone Number: | 9374016400 |
Business Fax Number: | |
Mailing Address: | 5077 Tewkesbury Dr, DAYTON |
State: | OH |
Postal Code: | 454243752 |
Phone Number: | 9372371018 |
Fax Number: | 9374396240 |
NPI Enumeration Date: | 03/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | AT-001528 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |