Provider Demographics
NPI:1073094157
Name:NEWBERRY, ERIC DAVID (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:NEWBERRY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8872 PROFESSIONAL DR STE C
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8482
Mailing Address - Country:US
Mailing Address - Phone:231-876-0010
Mailing Address - Fax:231-876-1246
Practice Address - Street 1:8872 PROFESSIONAL DR STE C
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8482
Practice Address - Country:US
Practice Address - Phone:231-876-0010
Practice Address - Fax:231-876-1246
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MI5501018865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist