Provider Demographics
NPI:1972705390
Name:BERRY, CHRISTINE ROBYN
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ROBYN
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:C
Other - Middle Name:ROBYN
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT CRR CCT CLDT
Mailing Address - Street 1:1952-5 PARK MEADOWS DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-939-4646
Mailing Address - Fax:239-939-1660
Practice Address - Street 1:1952-5 PARK MEADOWS DRIVE
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-939-4646
Practice Address - Fax:239-939-1660
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA018351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist