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General NPI Number Information
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NPI Number | 1487005963
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Entity Type | Individual
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Provider Name | CHARITY KRISTIN BERRIER CMT, ATC, LAT, NTP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 04/07/2017
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Provider Practice Location Address
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Address Line | 2525 N STOKESBERRY PL UNIT A
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City | MERIDIAN
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State | ID
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Zip | 83646-1510
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Country | US
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Telephone | 208-378-1517
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Fax | 208-939-8597
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Provider Business Mailing Address
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Address Line | 2525 N STOKESBERRY PL UNIT A
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City | MERIDIAN
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State | ID
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Zip | 83646-1510
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Country | US
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Telephone | 208-378-1517
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Fax | 208-939-8597
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT-255
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MASG-1536
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License Number State | ID
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