Provider Demographics
NPI:1356124572
Name:BERENDS, MIRTHE FREDERIEKE
Entity type:Individual
Prefix:
First Name:MIRTHE
Middle Name:FREDERIEKE
Last Name:BERENDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 JUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2223
Mailing Address - Country:US
Mailing Address - Phone:302-893-6181
Mailing Address - Fax:
Practice Address - Street 1:100 FITNESS WAY
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-2423
Practice Address - Country:US
Practice Address - Phone:302-234-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist