Individual provider · NPI-1

Fred Berman

Physical Therapy Assistant · Santa Fe, NM

NPI number1114274453
StatusActive
Last updated in NPPESAug 6, 2012

Details

NPI
1114274453
Entity type
Individual (NPI-1)
Name
Fred Berman
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 6, 2012
Last updated
Aug 6, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225200000X Physical Therapy AssistantA-1214NMYes

Practice location

720 Saint Michaels Dr
Santa Fe, NM 87505-7600

Phone 505-438-9402

Mailing address

1814 Paseo De La Conquistadora
Santa Fe, NM 87501-2341

Phone 505-795-8092

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