Provider Demographics
NPI:1023352416
Name:BERHALTER, PENNY (AS4833)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:BERHALTER
Suffix:
Gender:F
Credentials:AS4833
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 PINEBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285
Mailing Address - Country:US
Mailing Address - Phone:941-486-9300
Mailing Address - Fax:941-480-0182
Practice Address - Street 1:836 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-7123
Practice Address - Country:US
Practice Address - Phone:941-486-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4833237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist