Healthcare Provider Details

I. General information

NPI: 1881308807
Provider Name (Legal Business Name): DEE DEE MICHELLE BERGMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 KELLY JOHNSON BLVD STE 251
COLORADO SPRINGS CO
80920-3976
US

IV. Provider business mailing address

566 LARIMER CREEK DR
MONUMENT CO
80132-8899
US

V. Phone/Fax

Practice location:
  • Phone: 571-488-0117
  • Fax:
Mailing address:
  • Phone: 571-488-0117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: