Provider Demographics
NPI:1871169235
Name:BERRY, LUZVIMINDA (PT)
Entity type:Individual
Prefix:
First Name:LUZVIMINDA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LUZVIMINDA
Other - Middle Name:
Other - Last Name:MENDIOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:60 OVERLOCK RD
Mailing Address - Street 2:
Mailing Address - City:LEVANT
Mailing Address - State:ME
Mailing Address - Zip Code:04456-4513
Mailing Address - Country:US
Mailing Address - Phone:207-659-8750
Mailing Address - Fax:
Practice Address - Street 1:60 OVERLOCK RD
Practice Address - Street 2:
Practice Address - City:LEVANT
Practice Address - State:ME
Practice Address - Zip Code:04456-4513
Practice Address - Country:US
Practice Address - Phone:207-659-8750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist