Provider Demographics
NPI:1891738605
Name:BERMAN, ELIZABETH CELIA (PT, DPT, CIMT, CMTPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CELIA
Last Name:BERMAN
Suffix:
Gender:F
Credentials:PT, DPT, CIMT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:300B TEMPLE LAKE DR STE 1
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2973
Practice Address - Country:US
Practice Address - Phone:804-524-9036
Practice Address - Fax:804-524-9039
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1891738605Medicaid
VA192301OtherANTHEM JW PHYSICAL THERAP
VA192953OtherBCBS (PHYSICAL THERAPY)
VA98999OtherOPTIMA HEALTH
VA5856061OtherAETNA
VA258462OtherSOUTHERN HEALTH
VAC05954Medicare PIN
VA98999OtherOPTIMA HEALTH