Healthcare Provider Details

I. General information

NPI: 1225224215
Provider Name (Legal Business Name): SUSAN BERMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 HIGH ST
DEDHAM MA
02026-1857
US

IV. Provider business mailing address

644 HIGH ST
DEDHAM MA
02026-1857
US

V. Phone/Fax

Practice location:
  • Phone: 781-355-6657
  • Fax: 781-314-8163
Mailing address:
  • Phone: 781-355-6657
  • Fax: 781-314-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11123
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: