Provider Demographics
NPI:1184026049
Name:BERRO, MONEACH R (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MONEACH
Middle Name:R
Last Name:BERRO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MONEACH
Other - Middle Name:R
Other - Last Name:SURBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:206 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2418
Mailing Address - Country:US
Mailing Address - Phone:517-783-6670
Mailing Address - Fax:517-783-5310
Practice Address - Street 1:113 S EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2411
Practice Address - Country:US
Practice Address - Phone:517-990-6231
Practice Address - Fax:517-990-1283
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist