Healthcare Provider Details

I. General information

NPI: 1447883616
Provider Name (Legal Business Name): AMY BEDNAREK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10517 BRADDOCK RD STE D
FAIRFAX VA
22032-2275
US

IV. Provider business mailing address

PO BOX 1769
MIDDLEBURG VA
20118-1769
US

V. Phone/Fax

Practice location:
  • Phone: 571-351-5618
  • Fax: 571-351-5619
Mailing address:
  • Phone: 540-687-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213439
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: