Healthcare Provider Details

I. General information

NPI: 1922369172
Provider Name (Legal Business Name): MIRIAM BERTO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2581 HUNTCLIFF LN
PANAMA CITY FL
32405-4902
US

IV. Provider business mailing address

13807 FIDDLERS GREEN RD
PANAMA CITY FL
32409-3620
US

V. Phone/Fax

Practice location:
  • Phone: 850-252-0692
  • Fax:
Mailing address:
  • Phone: 850-890-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA109564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: