Provider Demographics
NPI:1528045176
Name:BERRY, PAUL ROBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ROBERT
Last Name:BERRY
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 1:103 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2372
Mailing Address - Country:US
Mailing Address - Phone:203-270-0330
Mailing Address - Fax:203-270-0330
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2372
Practice Address - Country:US
Practice Address - Phone:203-270-0330
Practice Address - Fax:203-270-0330
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTZS968OtherOXFORD HEALTH PLANS
0Q774710OtherEMPIRE BLUE CROSS BLUE SH
104823000OtherDOL FECA
CT0019501OtherAETNA ORTHONET
CT041801OtherHEALTHNET
CT080001915CT02OtherANTHEM BLUE CROSS &BLUE S
19501OtherCIGNA ORTHONET
0565313OtherAETNA
207806OtherWELLCARE
CTZS968OtherOXFORD HEALTH PLANS