Individual
JEREMY SCOTT BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
409 BENEDICTA AVE, TRINIDAD, CO 81082
(719) 846-9291
Mailing address
1606 HAYES STREET, TRINIDAD, CO 81082
(419) 309-0560
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0014693
CO
Other
Enumeration date
04/25/2023
Last updated
04/25/2023
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