Individual
TRAE BERKELEY JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
795 RIDGE LAKE BLVD STE 103, MEMPHIS, TN 38120-9475
(901) 255-6532
Mailing address
6435 AUTUMN OAKS DR, OLIVE BRANCH, MS 38654-6933
(662) 910-0353
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
7666
MS
225200000X
Physical Therapy Assistant
Primary
CP046707A
MD
Other
Enumeration date
12/07/2023
Last updated
07/17/2025
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