Provider Demographics
NPI:1942641188
Name:BERBERICH, BETH ANN (LMT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BERBERICH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 RINGWOOD MDWS
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-7221
Mailing Address - Country:US
Mailing Address - Phone:941-580-8003
Mailing Address - Fax:
Practice Address - Street 1:2170 ROBINHOOD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4528
Practice Address - Country:US
Practice Address - Phone:941-580-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62341225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist