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General NPI Number Information
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NPI Number | 1245746510
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Entity Type | Individual
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Provider Name | MATTHEW C BERGEN DPT
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Gender | Male
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 1005 VIRGINIA AVE STE 100
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City | ATLANTA
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State | GA
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Zip | 30354-1365
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Country | US
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Telephone | 404-362-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 140 SCHLEY AVE
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City | SAVANNAH
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State | GA
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Zip | 31419-3330
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Country | US
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Telephone | 912-323-5005
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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 | PT294186
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT012441
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License Number State | GA
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