Provider Demographics
NPI:1639258817
Name:BERKEY, LEE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LEE ANN
Middle Name:
Last Name:BERKEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LEE ANN
Other - Middle Name:
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:521 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8809
Mailing Address - Country:US
Mailing Address - Phone:814-289-1727
Mailing Address - Fax:910-845-3165
Practice Address - Street 1:521 S SHORE DR
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8809
Practice Address - Country:US
Practice Address - Phone:814-289-1727
Practice Address - Fax:910-845-3165
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8571208100000X
PAPT011203L225100000X
NCP11378208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist