Basic Information
| Provider Information | |||||||||
| NPI: | 1508471087 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERNIER | ||||||||
| FirstName: | AUSTIN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 THOMAS ST | ||||||||
| Address2: | |||||||||
| City: | FORT FAIRFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047423520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075519983 | ||||||||
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| Practice Location | |||||||||
| Address1: | 163 VAN BUREN RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047363588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074981618 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2020 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PA5733 | ME | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.