Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT 37350 | CA |
NPI | 1053616326 |
---|---|
Provider Name | Mrs. Ashley Brooke Berris |
First Address | Santa Cruz, CA 95062-2604 |
Second Address | Santa Cruz, CA 95062-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2011 |
Last Update Date | 18/01/2011 |