Healthcare Provider Details

I. General information

NPI: 1487425088
Provider Name (Legal Business Name): CAMERON BERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 BRYCE LN
FLOWER MOUND TX
75077-7038
US

IV. Provider business mailing address

4040 BRYCE LN
FLOWER MOUND TX
75077-7038
US

V. Phone/Fax

Practice location:
  • Phone: 940-241-1215
  • Fax:
Mailing address:
  • Phone: 940-241-1215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3132199
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: