Provider Demographics
NPI:1851584726
Name:BERRY, ELIZABETH M
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10622 SE TURNBERRY LOOP
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6994
Mailing Address - Country:US
Mailing Address - Phone:937-344-9549
Mailing Address - Fax:
Practice Address - Street 1:700 NE MULTNOMAH ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-4104
Practice Address - Country:US
Practice Address - Phone:503-295-2585
Practice Address - Fax:503-295-2587
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61470225100000X
OH007742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4230162Medicare PIN
OH4230161Medicare PIN