Provider Demographics
NPI:1912132341
Name:BERARDI, CAROLYN S (PT)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:S
Last Name:BERARDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 COLUMBUS AVENUE
Mailing Address - Street 2:PROACTIVE PHYSICAL THERAPY
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-741-2850
Mailing Address - Fax:
Practice Address - Street 1:401 COLUMBUS AVE
Practice Address - Street 2:PROACTIVE PHYSICAL THERAPY
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1325
Practice Address - Country:US
Practice Address - Phone:914-741-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013133-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist