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General NPI Number Information
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NPI Number | 1245036144
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Entity Type | Individual
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Provider Name | JESSICA BERGGREN
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Gender | Female
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 555 HIGHLAND AVE
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City | MILFORD
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State | MI
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Zip | 48381-1517
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Country | US
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Telephone | 248-685-1460
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Fax |
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Provider Business Mailing Address
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Address Line | 14019 PLACID DR
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City | HOLLY
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State | MI
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Zip | 48442-8308
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Country | US
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Telephone | 810-265-0857
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502008703
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License Number State | MI
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