Provider Demographics
NPI:1154207272
Name:BERRIOS RODRIGUEZ, MARCOS ADELMO
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:ADELMO
Last Name:BERRIOS RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MONTGOMERY CIR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-5905
Mailing Address - Country:US
Mailing Address - Phone:540-877-0765
Mailing Address - Fax:
Practice Address - Street 1:123 MONTGOMERY CIR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-5905
Practice Address - Country:US
Practice Address - Phone:540-877-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist