Provider Demographics
NPI:1962014910
Name:BERKOFSKY, LIANA M
Entity Type:Individual
Prefix:
First Name:LIANA
Middle Name:M
Last Name:BERKOFSKY
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 1:5372 BEARUP ST
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-2203
Mailing Address - Country:US
Mailing Address - Phone:941-421-4091
Mailing Address - Fax:
Practice Address - Street 1:5372 BEARUP ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-2203
Practice Address - Country:US
Practice Address - Phone:941-421-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist