Provider Demographics
NPI:1538543467
Name:BERRY, CHRISTOPHER S (MSPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:BERRY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:126 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4206
Mailing Address - Country:US
Mailing Address - Phone:318-272-4245
Mailing Address - Fax:318-631-9528
Practice Address - Street 1:8660 FERN AVE STE 160
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5694
Practice Address - Country:US
Practice Address - Phone:318-631-9999
Practice Address - Fax:318-631-9528
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA051412251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics