Provider Demographics
NPI:1558194647
Name:BERNE, SERVIO R (MA)
Entity type:Individual
Prefix:
First Name:SERVIO
Middle Name:R
Last Name:BERNE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 ASHTON PARK WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2563
Mailing Address - Country:US
Mailing Address - Phone:863-206-6488
Mailing Address - Fax:
Practice Address - Street 1:18111 ASHTON PARK WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2563
Practice Address - Country:US
Practice Address - Phone:863-206-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100287225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist