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NPI Code Detail

MEDICARE: MR. NED HARLOW BERGERT MS ATC PTA

MEDICARE:  MR. NED HARLOW BERGERT  MS ATC PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantAT2979CA
22255A2300XAthletic Trainer0362AZ

General Provider Information

NPI Number : 1871620054
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NED HARLOW BERGERT MS ATC PTA
Provider Business Mailing Address
First Line : 2000 GENE AUTRY WAY
Second Line :
City : ANAHEIM
State : CA
Zip : 92806-2000
Country : US
Telephone Number : 714-940-2043
Fax Number : 714-940-2240
Provider Business Practice Location Address
First Line : 2000 E GENE AUTRY WAY
Second Line :
City : ANAHEIM
State : CA
Zip : 92806-6143
Country : US
Telephone Number : 714-940-2043
Fax Number : 714-940-2240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 09/11/2025

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Directions to “ MR. NED HARLOW BERGERT MS ATC PTA” Practice Location

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