Healthcare Provider Details

I. General information

NPI: 1902354053
Provider Name (Legal Business Name): BERRY'S PROSTHETICS & ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SWINGING BRIDGE DR
BYRAM MS
39272-5928
US

IV. Provider business mailing address

115 SWINGING BRIDGE DR
BYRAM MS
39272-5928
US

V. Phone/Fax

Practice location:
  • Phone: 769-251-0555
  • Fax: 769-251-0366
Mailing address:
  • Phone: 769-251-0555
  • Fax: 769-251-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KAREN TERESA BERRY
Title or Position: CEO
Credential:
Phone: 769-251-0555