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Individual
MRS. STEPHANIE KROK BERRY
Active
Individual
MRS. STEPHANIE KROK BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001143
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042751
HEALTHNET
—
01
—
080001143CT03
ANTHEM BLUE CROSS & BLUE
CT
01
—
221657
WELLCARE
—
01
—
Q30Y4
EMPIRE BLUE CROSS BLUE SH
—
Enumeration date
12/27/2005
Last updated
11/21/2007
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