Provider Demographics
NPI:1487005963
Name:BERRIER, CHARITY KRISTIN (CMT, ATC, LAT, NTP)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:KRISTIN
Last Name:BERRIER
Suffix:
Gender:F
Credentials:CMT, ATC, LAT, NTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N STOKESBERRY PL UNIT A
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-1510
Mailing Address - Country:US
Mailing Address - Phone:208-378-1517
Mailing Address - Fax:208-939-8597
Practice Address - Street 1:2525 N STOKESBERRY PL UNIT A
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-1510
Practice Address - Country:US
Practice Address - Phone:208-378-1517
Practice Address - Fax:208-939-8597
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-255174400000X
IDMASG-1536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist