Basic Information
| Provider Information | |||||||||
| NPI: | 1891738605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERMAN | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CELIA | ||||||||
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| Credential: | PT, DPT, CIMT, CMTPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 69030 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212649030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578732302 | ||||||||
| FaxNumber: | 7578732306 | ||||||||
| Practice Location | |||||||||
| Address1: | 300B TEMPLE LAKE DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | COLONIAL HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238342973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045249036 | ||||||||
| FaxNumber: | 8045249039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 04/12/2018 | ||||||||
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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 | 2305203929 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1891738605 | 05 | VA | MEDICAID | 192301 | 01 | VA | ANTHEM JW PHYSICAL THERAP | OTHER | 192953 | 01 | VA | BCBS (PHYSICAL THERAPY) | OTHER | 98999 | 01 | VA | OPTIMA HEALTH | OTHER | 5856061 | 01 | VA | AETNA | OTHER | 258462 | 01 | VA | SOUTHERN HEALTH | OTHER |