Healthcare Provider Details

I. General information

NPI: 1881118016
Provider Name (Legal Business Name): MICHAEL BERLAM PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW STE 700
ATLANTA GA
30327-5308
US

IV. Provider business mailing address

1527 DRUID OAKS NE
ATLANTA GA
30329-3278
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-0743
  • Fax: 855-238-0019
Mailing address:
  • Phone: 860-389-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013013
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT013013
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: