Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 16439 | MD |
N | 225100000X | Physical Therapist | PT20119 | FL |
NPI | 1003025156 |
---|---|
Provider Name | Joseph Charles Berry |
First Address | Fairfax, VA 22033-5734 |
Second Address | Fairfax, VA 22033-5734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |