Provider Demographics
NPI:1508471087
Name:BERNIER, AUSTIN (PTA)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BERNIER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-3520
Mailing Address - Country:US
Mailing Address - Phone:207-551-9983
Mailing Address - Fax:
Practice Address - Street 1:163 VAN BUREN RD STE 1
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3588
Practice Address - Country:US
Practice Address - Phone:207-498-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA5733225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant