Provider Demographics
NPI:1366870826
Name:BERBERICH, COURTNEY JOHNSON
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JOHNSON
Last Name:BERBERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DIANE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8081 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4313
Mailing Address - Country:US
Mailing Address - Phone:214-239-0993
Mailing Address - Fax:214-239-0998
Practice Address - Street 1:8081 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4313
Practice Address - Country:US
Practice Address - Phone:214-239-0993
Practice Address - Fax:214-239-0998
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1233315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist