MEDICARE: MS. JULIE A BERRIDGE PT CHT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4346	OR
2	2251H1200X	Hand Physical Therapist	9911000219	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1088466	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1093833055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE A BERRIDGE PT CHT

Provider Business Mailing Address
First Line	:	P.O. BOX 4356
Second Line	:	DEPT. 665
City	:	HOUSTON
State	:	TX
Zip	:	77210-4356
Country	:	US
Telephone Number	:	281-440-6960
Fax Number	:	280-440-6205

Provider Business Practice Location Address
First Line	:	17270 RED OAK DR
Second Line	:	SUITE 200
City	:	HOUSTON
State	:	TX
Zip	:	77090-2618
Country	:	US
Telephone Number	:	281-440-6960
Fax Number	:	281-440-6205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/16/2015

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