Provider Demographics
NPI:1164272894
Name:BERRYMAN, SABRENA DELIGHT (LMT)
Entity Type:Individual
Prefix:
First Name:SABRENA
Middle Name:DELIGHT
Last Name:BERRYMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 E END RD UNIT 15
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9426
Mailing Address - Country:US
Mailing Address - Phone:907-299-8090
Mailing Address - Fax:
Practice Address - Street 1:3585 E END RD STE A
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-9426
Practice Address - Country:US
Practice Address - Phone:907-299-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK114122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist