Provider Demographics
NPI:1407032881
Name:BERRY, H EUGENE JR (LMP)
Entity Type:Individual
Prefix:MR
First Name:H
Middle Name:EUGENE
Last Name:BERRY
Suffix:JR
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58871 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-3628
Mailing Address - Country:US
Mailing Address - Phone:360-448-0787
Mailing Address - Fax:
Practice Address - Street 1:5305 E 18TH ST
Practice Address - Street 2:SUITE 151
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6583
Practice Address - Country:US
Practice Address - Phone:360-448-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022620225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist