Active NPI
Brian R Berry
- Physical Therapy Assistant
- Hunnewell, MO
National Provider Identifier
1578084786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2016020955
- Practice address
- 107 E Walnut St
Hunnewell, MO 63443-3051 - Phone
- (660) 853-0023
- NPI assigned
- Jun 28, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2016020955 | MO | Primary |
Addresses
Primary practice location
107 E Walnut St
Hunnewell, MO 63443-3051
Mailing address
3388 Falcon Crest Dr
Bridgeton, MO 63044-3174
Phone (660) 853-0023
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016020955 | MO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498608000000",
"number": "1578084786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3388 FALCON CREST DR",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630443174",
"telephone_number": "660-853-0023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 E WALNUT ST",
"city": "HUNNEWELL",
"state": "MO",
"postal_code": "634433051",
"telephone_number": "660-853-0023"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY",
"first_name": "BRIAN",
"middle_name": "R",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-28",
"last_updated": "2017-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "MO",
"license": "2016020955",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.