Provider Demographics
NPI:1902783988
Name:BERRY, CORA LEE (CNA, LMT, LE)
Entity type:Individual
Prefix:
First Name:CORA
Middle Name:LEE
Last Name:BERRY
Suffix:
Gender:F
Credentials:CNA, LMT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29611-5019
Mailing Address - Country:US
Mailing Address - Phone:864-526-1173
Mailing Address - Fax:
Practice Address - Street 1:209 PATEWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3588
Practice Address - Country:US
Practice Address - Phone:864-522-6630
Practice Address - Fax:864-522-6635
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13078225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist