Provider Demographics
NPI:1487420683
Name:MACROPOULOS BERRY, CHRISTINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MACROPOULOS BERRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:NICOLE
Other - Last Name:MACROPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:11 FLAGSHIP LN
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-1968
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 SOUTHERN JUNCTION BLVD
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2214
Practice Address - Country:US
Practice Address - Phone:912-348-8350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT890026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist