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General NPI Number Information
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NPI Number | 1568004489
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Entity Type | Individual
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Provider Name | JOHN BERLIN PTA
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Gender | Male
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 10/11/2019
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Provider Practice Location Address
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Address Line | 355 FM 83 W
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City | HEMPHILL
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State | TX
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Zip | 75948-8300
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Country | US
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Telephone | 409-787-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 396 FM 2694
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City | SHELBYVILLE
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State | TX
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Zip | 75973-2754
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Country | US
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Telephone | 480-532-5627
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2133501
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License Number State | TX
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