Provider Demographics
NPI:1881118016
Name:BERLAM, MICHAEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BERLAM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 DRUID OAKS NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3278
Mailing Address - Country:US
Mailing Address - Phone:860-389-3773
Mailing Address - Fax:
Practice Address - Street 1:3200 DOWNWOOD CIR NW STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-5308
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:855-238-0019
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-30
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0130132251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic