Provider Demographics
NPI:1659499879
Name:BERKOW, MARLENE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:
Last Name:BERKOW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NW 43RD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6632
Mailing Address - Country:US
Mailing Address - Phone:352-379-2948
Mailing Address - Fax:
Practice Address - Street 1:2727 NW 43RD ST
Practice Address - Street 2:SUITE 3
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6632
Practice Address - Country:US
Practice Address - Phone:352-379-2948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM23283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7720OtherBCBS PROVIDER #