=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336171933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNADINE GEMMA AGUIRRE RPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 CECIL D QUILLEN DR
-----------------------------------------------------
City | DUFFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24244-9726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-431-3141
-----------------------------------------------------
Fax | 276-431-3143
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9790 TANGLEWOOD DRIVE
-----------------------------------------------------
City | WISE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-356-2698
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305005934
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------