Healthcare Provider Details

I. General information

NPI: 1902079320
Provider Name (Legal Business Name): CYNTHIA LOUISE BERG P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 W FOREST HOME AVE
HALES CORNERS WI
53130-1611
US

IV. Provider business mailing address

9449 W FOREST HOME AVE
HALES CORNERS WI
53130-1611
US

V. Phone/Fax

Practice location:
  • Phone: 414-529-6888
  • Fax: 414-529-1271
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2767-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: