Provider Demographics
NPI:1952552721
Name:BERRY, TWILA J
Entity Type:Individual
Prefix:
First Name:TWILA
Middle Name:J
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-1187
Mailing Address - Country:US
Mailing Address - Phone:907-283-2765
Mailing Address - Fax:
Practice Address - Street 1:150 N WILLOW ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7701
Practice Address - Country:US
Practice Address - Phone:907-283-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist