Provider Demographics
NPI:1598929093
Name:BERRY, KATIE (PTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:DEKKENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:535 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-1608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:535 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1608
Practice Address - Country:US
Practice Address - Phone:303-777-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant