Provider Demographics
NPI:1508834573
Name:HALL, BERNADETTE WILEY (PT)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:WILEY
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12806 WORSHAM GREEN CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3143
Mailing Address - Country:US
Mailing Address - Phone:610-393-1976
Mailing Address - Fax:804-524-0133
Practice Address - Street 1:320B CHARLES H DIMMOCK PKWY STE 6
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2938
Practice Address - Country:US
Practice Address - Phone:804-524-0533
Practice Address - Fax:804-524-0133
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist