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General NPI Number Information
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NPI Number | 1073044558
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Entity Type | Individual
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Provider Name | MARA NATALIE BERGEE DPT
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Gender | Female
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 03/25/2017
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Provider Practice Location Address
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Address Line | 3821 S CHICAGO AVE
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City | SOUTH MILWAUKEE
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State | WI
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Zip | 53172-3712
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Country | US
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Telephone | 414-762-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 711 E CENTER ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-2944
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Country | US
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Telephone | 651-353-1406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13585-24
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License Number State | WI
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