Provider Demographics
NPI:1821212168
Name:BERRY, LALITA (PT)
Entity Type:Individual
Prefix:MRS
First Name:LALITA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12505 ANAND BROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-1076
Mailing Address - Country:US
Mailing Address - Phone:708-878-8344
Mailing Address - Fax:708-364-7310
Practice Address - Street 1:10723 WINTERSET DRIVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-1106
Practice Address - Country:US
Practice Address - Phone:708-364-1098
Practice Address - Fax:708-364-7310
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL74111Medicare ID - Type Unspecified