Provider Demographics
NPI:1821685884
Name:BERRY, GAYLE (PTA)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CROWNINSHIELD ST UNIT 410
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-8206
Mailing Address - Country:US
Mailing Address - Phone:978-423-1397
Mailing Address - Fax:
Practice Address - Street 1:8 CROWNINSHIELD ST UNIT 410
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8206
Practice Address - Country:US
Practice Address - Phone:978-423-1397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2695225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant