Provider Demographics
NPI:1861792095
Name:BERAK, PATRICIA C (NCTMB)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:C
Last Name:BERAK
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 WIEGAND
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1461
Mailing Address - Country:US
Mailing Address - Phone:586-758-5266
Mailing Address - Fax:
Practice Address - Street 1:7302 WIEGAND
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1461
Practice Address - Country:US
Practice Address - Phone:586-758-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist