Provider Demographics
NPI:1629208343
Name:DENNIS, BERTHA M (NCMT)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:M
Last Name:DENNIS
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:M
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCMT
Mailing Address - Street 1:COMMUNITY THERAPY 519 PEARL STREET
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723
Mailing Address - Country:US
Mailing Address - Phone:989-325-1526
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY THERAPY 519 PEARL STREET
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723
Practice Address - Country:US
Practice Address - Phone:989-325-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI563458-08225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist