Provider Demographics
NPI:1396741989
Name:BERRYHILL, JOHN (RPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BERRYHILL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 E 800 S
Mailing Address - Street 2:STE B
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-9673
Mailing Address - Country:US
Mailing Address - Phone:435-563-0750
Mailing Address - Fax:
Practice Address - Street 1:136 E 800 S
Practice Address - Street 2:STE B
Practice Address - City:SMITHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84335-9673
Practice Address - Country:US
Practice Address - Phone:435-563-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005792001Medicare ID - Type Unspecified