Healthcare Provider Details

I. General information

NPI: 1861414401
Provider Name (Legal Business Name): MATTHEW BERNIER MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 TELESTAR CT
FALLS CHURCH VA
22042-1206
US

IV. Provider business mailing address

2922 TELESTAR CT
FALLS CHURCH VA
22042-1206
US

V. Phone/Fax

Practice location:
  • Phone: 703-769-8420
  • Fax: 703-553-8647
Mailing address:
  • Phone: 703-769-8420
  • Fax: 703-553-8647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305203024
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: