Provider Demographics
NPI:1629773270
Name:BERRY, NICOLAS CESAR (MS,LAT,ATC)
Entity Type:Individual
Prefix:
First Name:NICOLAS
Middle Name:CESAR
Last Name:BERRY
Suffix:
Gender:M
Credentials:MS,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NE
Mailing Address - Zip Code:68421-3096
Mailing Address - Country:US
Mailing Address - Phone:209-321-2210
Mailing Address - Fax:
Practice Address - Street 1:812 6TH ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NE
Practice Address - Zip Code:68421-3096
Practice Address - Country:US
Practice Address - Phone:209-321-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer