Provider Demographics
NPI:1508969502
Name:BERKEMEYER, DONALD J (PT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:BERKEMEYER
Suffix:
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 1:111 WELLINGTON PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1758
Mailing Address - Country:US
Mailing Address - Phone:513-961-4700
Mailing Address - Fax:513-961-1912
Practice Address - Street 1:10550 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4498
Practice Address - Country:US
Practice Address - Phone:513-984-5556
Practice Address - Fax:513-791-5306
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-01585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2377879Medicaid
7855688OtherAETNA
000000361765OtherANTHEM
OHBE0869092Medicare ID - Type Unspecified