Provider Demographics
NPI:1043860646
Name:BIERWIRTH-POLITE, PETRA
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:
Last Name:BIERWIRTH-POLITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 BULL RUN DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4762
Mailing Address - Country:US
Mailing Address - Phone:254-245-1126
Mailing Address - Fax:
Practice Address - Street 1:1200 E STAN SCHLUETER LOOP STE 108
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5482
Practice Address - Country:US
Practice Address - Phone:254-833-5311
Practice Address - Fax:254-833-5311
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst