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General NPI Number Information
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NPI Number | 1427429968
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Entity Type | Individual
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Provider Name | MR. JEFFREY BERGER JR.
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Gender | Male
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 1221 S CLEARVIEW PKWY
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City | JEFFERSON
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State | LA
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Zip | 70121-1011
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Country | US
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Telephone | 504-905-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 612 WILLOWRIDGE DR
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City | LULING
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State | LA
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Zip | 70070-3217
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Country | US
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Telephone | 504-905-4395
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2255A2300X
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License Number State | LA
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