Healthcare Provider Details

I. General information

NPI: 1558067280
Provider Name (Legal Business Name): HALEY PAULINE BERMAN PT, DPT, CSRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CLEAR WATER RD
GORDON KY
41819-9009
US

IV. Provider business mailing address

90 CLEAR WATER RD
GORDON KY
41819-9009
US

V. Phone/Fax

Practice location:
  • Phone: 606-303-4848
  • Fax:
Mailing address:
  • Phone: 606-303-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008740
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: