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General NPI Number Information
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NPI Number | 1366047128
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Entity Type | Individual
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Provider Name | YITZCHAK BERGER DPT
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Gender | Male
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 440 CORWIN NIXON BLVD STE S
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City | SOUTH LEBANON
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State | OH
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Zip | 45065-1196
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Country | US
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Telephone | 513-770-0333
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Fax | 513-770-0231
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Provider Business Mailing Address
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Address Line | 6480 HARRISON AVE STE 201
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City | CINCINNATI
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State | OH
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Zip | 45247-7961
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Country | US
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Telephone | 513-770-0333
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Fax | 513-770-0231
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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 | PT018923
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License Number State | OH
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