Provider Demographics
NPI:1417961236
Name:BERK, ERIN MORAN (DPT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MORAN
Last Name:BERK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:FLINT
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11240 WAPLES MILL ROAD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-385-4707
Mailing Address - Fax:703-691-4933
Practice Address - Street 1:8320 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 401
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3831
Practice Address - Country:US
Practice Address - Phone:703-288-7864
Practice Address - Fax:703-288-7869
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204404225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA017943C95Medicare ID - Type Unspecified