Healthcare Provider Details

I. General information

NPI: 1932457330
Provider Name (Legal Business Name): HOLLY MICHELE BERGER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY THOMAS PT

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 S ALASKA ST STE 209
PALMER AK
99645-6378
US

IV. Provider business mailing address

642 S ALASKA ST STE 209
PALMER AK
99645-6378
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-0722
  • Fax:
Mailing address:
  • Phone: 907-746-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4421
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29680
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2012015111
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number119824
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04437
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: