Provider Demographics
NPI:1215364054
Name:BERRY, CARRIE E (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:E
Last Name:BERRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:CARRIE
Other - Middle Name:E
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1305 WAKARUSA DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3830
Mailing Address - Country:US
Mailing Address - Phone:785-842-3444
Mailing Address - Fax:785-842-3410
Practice Address - Street 1:1305 WAKARUSA DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3830
Practice Address - Country:US
Practice Address - Phone:785-842-3444
Practice Address - Fax:785-842-3410
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02541225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant