Provider Demographics
NPI:1275151870
Name:BERTHIAUME, SOOJI
Entity Type:Individual
Prefix:
First Name:SOOJI
Middle Name:
Last Name:BERTHIAUME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1152 ISHEE DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6678
Mailing Address - Country:US
Mailing Address - Phone:203-819-1751
Mailing Address - Fax:
Practice Address - Street 1:1210 W CREEK COYOTE TRL
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-6385
Practice Address - Country:US
Practice Address - Phone:931-503-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer