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Individual

MRS. TERRI LAKE BERKSHIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS PT

Contact information

Practice address
1500 MUSEUM ROAD SUITE 104, CONWAY THERAPY SERVICES, CONWAY, AR 72032
(501) 329-3804
(801) 329-0718
Mailing address
1500 MUSEUM ROAD SUITE 104, CONWAY THERAPY SERVICES, CONWAY, AR 72032
(501) 329-3804
(801) 329-0718

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2305203594
VA
225100000X
Physical Therapist
Primary
2472
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
142131721
AR
Enumeration date
05/22/2006
Last updated
03/07/2019
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