Healthcare Provider Details

I. General information

NPI: 1245616655
Provider Name (Legal Business Name): CASSANDRA RUTH BERGHAMMER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 CLIZBE AVE
AMSTERDAM NY
12010-2935
US

IV. Provider business mailing address

42 SARATOGA RD
SCOTIA NY
12302-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-1425
  • Fax: 518-842-1706
Mailing address:
  • Phone: 518-399-6861
  • Fax: 518-399-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: