Provider Demographics
NPI:1255782744
Name:BERKELEY, MARSHALL HUNTER (DPT)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:HUNTER
Last Name:BERKELEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STRATFORD GREEN DR APT 3
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:835 MCKAY CT STE 100
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5786
Practice Address - Country:US
Practice Address - Phone:330-965-3899
Practice Address - Fax:330-965-3839
Is Sole Proprietor?:No
Enumeration Date:2016-06-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist