Provider Demographics
NPI:1811537459
Name:BERRY, TAWMIE DENISE-SKY (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:TAWMIE
Middle Name:DENISE-SKY
Last Name:BERRY
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6166 S INEZ DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4200
Mailing Address - Country:US
Mailing Address - Phone:480-636-9754
Mailing Address - Fax:
Practice Address - Street 1:6166 S INEZ DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4200
Practice Address - Country:US
Practice Address - Phone:480-636-9754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0091042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer