Provider Demographics
NPI:1164276416
Name:BERRY, KIMBERLY (PT, MPT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2210
Mailing Address - Country:US
Mailing Address - Phone:937-422-3106
Mailing Address - Fax:
Practice Address - Street 1:940 S ELM ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2210
Practice Address - Country:US
Practice Address - Phone:937-422-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist