Individual
BERNA AMISTOSO VIADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3264 KAISER DR, ELLICOTT CITY, MD 21043-4555
(410) 750-9006
Mailing address
3264 KAISER DR, ELLICOTT CITY, MD 21043-4555
(410) 750-9006
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
030405
NY
225100000X
Physical Therapist
5501014363
MI
225100000X
Physical Therapist
Primary
PT871011
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030405
NEW YORK PT LICENSE
—
01
—
5501014363
MI PT LICENSE
—
01
—
PT871011
DC PT LICENSE
—
Enumeration date
04/26/2009
Last updated
04/26/2009
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