Provider Demographics
NPI:1225789324
Name:BERENYI, GARTH ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:GARTH
Middle Name:ANDREW
Last Name:BERENYI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S LEVANT RD
Mailing Address - Street 2:
Mailing Address - City:LEVANT
Mailing Address - State:ME
Mailing Address - Zip Code:04456-4338
Mailing Address - Country:US
Mailing Address - Phone:207-852-2563
Mailing Address - Fax:
Practice Address - Street 1:34 GILMAN RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3516
Practice Address - Country:US
Practice Address - Phone:207-941-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist