Provider Demographics
NPI:1992813299
Name:HERSHBERGER, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:HERSHBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EASTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1509
Mailing Address - Country:US
Mailing Address - Phone:301-787-0989
Mailing Address - Fax:
Practice Address - Street 1:3 BETHESDA METRO CTR # B001
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5330
Practice Address - Country:US
Practice Address - Phone:301-986-9252
Practice Address - Fax:301-718-6152
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPT870789OtherLICENSE #
VA2305205020OtherLICENSE #
MD20716OtherLICENSE #