Healthcare Provider Details

I. General information

NPI: 1336171933
Provider Name (Legal Business Name): BERNADINE GEMMA AGUIRRE RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 CECIL D QUILLEN DR
DUFFIELD VA
24244-9726
US

IV. Provider business mailing address

9790 TANGLEWOOD DRIVE
WISE VA
24293
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-3141
  • Fax: 276-431-3143
Mailing address:
  • Phone: 276-356-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305005934
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: