Provider Demographics
NPI:1386654911
Name:ROBERT G BERRY JR LTD
Entity Type:Organization
Organization Name:ROBERT G BERRY JR LTD
Other - Org Name:ORTHOPEDIC REHABILITATION SPECIALIST OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GEORGETTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-448-9456
Mailing Address - Street 1:6630 S MCCARRAN BLVD STE A3
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6136
Mailing Address - Country:US
Mailing Address - Phone:775-828-2863
Mailing Address - Fax:775-448-9447
Practice Address - Street 1:6630 S MCCARRAN BLVD STE A3
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6184
Practice Address - Country:US
Practice Address - Phone:775-828-2863
Practice Address - Fax:866-571-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV208100000X
208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV31527Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER