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General NPI Number Information
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NPI Number | 1093187072
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Entity Type | Individual
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Provider Name | LAURA BERRY LMT, NMT
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Gender | Female
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 8635 RIVER ROCK CT
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City | BALL GROUND
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State | GA
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Zip | 30107-3592
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Country | US
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Telephone | 770-403-2291
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Fax |
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Provider Business Mailing Address
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Address Line | 8635 RIVER ROCK CT
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City | BALL GROUND
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State | GA
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Zip | 30107-3592
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Country | US
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Telephone | 770-403-2291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT006924
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License Number State | GA
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