Basic Information
| Provider Information | |||||||||
| NPI: | 1679134894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERLIN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | WHITNEY NASON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 624 HODSDON RD # 2 | ||||||||
| Address2: | |||||||||
| City: | POWNAL | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040696407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079398606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 BRAMHALL ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076624892 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2019 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.