Provider Demographics
NPI:1851449052
Name:PAUL R & STEPHANIE K BERRY DBA PHYSICAL THERAPY CONSULTANTS
Entity Type:Organization
Organization Name:PAUL R & STEPHANIE K BERRY DBA PHYSICAL THERAPY CONSULTANTS
Other - Org Name:PHYSICAL THERAPY SERVICES OF NEWTOWN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-270-0330
Mailing Address - Street 1:103 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2372
Mailing Address - Country:US
Mailing Address - Phone:203-270-0330
Mailing Address - Fax:203-270-0330
Practice Address - Street 1:103 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2372
Practice Address - Country:US
Practice Address - Phone:203-270-0330
Practice Address - Fax:203-270-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1851449052Medicare PIN