Individual
ANGELA BERNAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1250 S A W GRIMES BLVD, ROUND ROCK, TX 78664-7429
(512) 310-7665
(512) 310-9228
Mailing address
1250 S A W GRIMES BLVD, ROUND ROCK, TX 78664-7429
(512) 310-7665
(512) 310-9228
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2089400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031DG
BLUE CROSS BLUE SHIELD
—
05
—
0944746-02
—
TX
Enumeration date
10/03/2012
Last updated
10/03/2012
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