Healthcare Provider Details

I. General information

NPI: 1790164416
Provider Name (Legal Business Name): AARON PAUL BERGEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N STATE ROUTE 7 STE B
PLEASANT HILL MO
64080-9303
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 816-987-7049
  • Fax: 816-987-2606
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0013315
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: