Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1242412 | TX |
NPI | 1376056325 |
---|---|
Provider Name | Dr. Tonda Kaye Berry |
First Address | Euless, TX 76039-2544 |
Second Address | Fort Worth, TN 76110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2017 |
Last Update Date | 13/11/2017 |