Provider Demographics
NPI:1205656303
Name:BERRIOS, ANDRES ISAIAH
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:ISAIAH
Last Name:BERRIOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8972 W KATHLEEN RD # 85382
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3727
Mailing Address - Country:US
Mailing Address - Phone:623-383-5760
Mailing Address - Fax:
Practice Address - Street 1:6630 W CACTUS RD STE B112
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1662
Practice Address - Country:US
Practice Address - Phone:623-469-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant