Provider Demographics
NPI:1720189863
Name:BERMAN, JOSEPH EZRA (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EZRA
Last Name:BERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SCI-128 ZABLOCKI VA MEDICAL CTR
Mailing Address - Street 2:5000 W NATIONAL AVE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-807-6296
Mailing Address - Fax:414-382-5293
Practice Address - Street 1:SCI-128 ZABLOCKI VA MEDICAL CTR
Practice Address - Street 2:5000 W NATIONAL AVE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-807-6296
Practice Address - Fax:414-382-5293
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist