Provider Demographics
NPI:1457040487
Name:BERRY, DEBORAH DEAN
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:DEAN
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:BERRY
Other - Last Name:FOUCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:989 S MAIN ST.
Mailing Address - Street 2:A-261
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326
Mailing Address - Country:US
Mailing Address - Phone:928-862-0148
Mailing Address - Fax:
Practice Address - Street 1:7749 E. FLORENTINE RD.
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-772-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist