Provider Demographics
NPI:1861414401
Name:BERNIER, MATTHEW (MPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BERNIER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 TELESTAR CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1206
Mailing Address - Country:US
Mailing Address - Phone:703-769-8420
Mailing Address - Fax:703-553-8647
Practice Address - Street 1:2922 TELESTAR CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1206
Practice Address - Country:US
Practice Address - Phone:703-769-8420
Practice Address - Fax:703-553-8647
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014147C95Medicare ID - Type Unspecified