Healthcare Provider Details

I. General information

NPI: 1922914076
Provider Name (Legal Business Name): JESSICA DAWN BERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E RIVERVIEW AVE
FORT MORGAN CO
80701-3262
US

IV. Provider business mailing address

19498 MARIGOLD DR
STERLING CO
80751-8513
US

V. Phone/Fax

Practice location:
  • Phone: 970-520-7174
  • Fax:
Mailing address:
  • Phone: 970-520-7174
  • Fax: 970-520-7174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0014681
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: