Provider Demographics
NPI:1598012510
Name:BERMAN, MICHAEL (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12671 US HIGHWAY 98 W
Mailing Address - Street 2:SUITE 213
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32550-8300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12671 US HIGHWAY 98 W
Practice Address - Street 2:SUITE 213
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32550-8300
Practice Address - Country:US
Practice Address - Phone:850-650-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGP689ZOtherMEDICARE PTAN