Provider Demographics
NPI:1538345723
Name:BERRY, MICHAEL PATRICK (LAT, CSCS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:BERRY
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Gender:M
Credentials:LAT, CSCS
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Mailing Address - Street 1:1 BROOKINGS DR
Mailing Address - Street 2:CAMPUS BOX 1067
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4862
Mailing Address - Country:US
Mailing Address - Phone:314-935-6461
Mailing Address - Fax:314-935-8789
Practice Address - Street 1:1 BROOKINGS DR
Practice Address - Street 2:CAMPUS BOX 1067
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4862
Practice Address - Country:US
Practice Address - Phone:314-935-6461
Practice Address - Fax:314-935-8789
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2023-08-28
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Provider Licenses
StateLicense IDTaxonomies
MO1113912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer