Basic Information
| Provider Information | |||||||||
| NPI: | 1124284799 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENBERG | ||||||||
| FirstName: | BARRIE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 511 OLD LANCASTER RD STE 12 | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193121671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102252451 | ||||||||
| FaxNumber: | 6109646166 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 OLD LANCASTER RD STE 12 | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193121671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102252451 | ||||||||
| FaxNumber: | 6109646166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 08/05/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | PT019227 | PA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 9946194 | 01 | PA | AETNA | OTHER |