Provider Demographics
NPI:1124392279
Name:BERRY, AZLYNN ELIZABETH (MT)
Entity Type:Individual
Prefix:MS
First Name:AZLYNN
Middle Name:ELIZABETH
Last Name:BERRY
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5738 WHITSETT AVE
Mailing Address - Street 2:SUITE NUMBER 206
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-1575
Mailing Address - Country:US
Mailing Address - Phone:818-336-1579
Mailing Address - Fax:818-880-6689
Practice Address - Street 1:4937 LAS VIRGENES RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CALABASES
Practice Address - State:CA
Practice Address - Zip Code:91302-3559
Practice Address - Country:US
Practice Address - Phone:818-336-1579
Practice Address - Fax:818-880-6689
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA8244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist