Healthcare Provider Details

I. General information

NPI: 1780574228
Provider Name (Legal Business Name): JAREK BERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 S 27TH ST
FRANKLIN WI
53132-7209
US

IV. Provider business mailing address

3704 S 69TH ST
MILWAUKEE WI
53220-1813
US

V. Phone/Fax

Practice location:
  • Phone: 414-325-4850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number16753-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: