Provider Demographics
NPI:1235294877
Name:BERRY, ALPHONSO R JR (PT)
Entity Type:Individual
Prefix:
First Name:ALPHONSO
Middle Name:R
Last Name:BERRY
Suffix:JR
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 1:212 KNICKERBOCKER DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4729
Mailing Address - Country:US
Mailing Address - Phone:877-379-3789
Mailing Address - Fax:
Practice Address - Street 1:3001 JACKS RUN RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15131-2538
Practice Address - Country:US
Practice Address - Phone:877-379-3789
Practice Address - Fax:412-374-8050
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007048L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113206WU6Medicare PIN