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General NPI Number Information
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NPI Number | 1750528600
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Entity Type | Individual
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Provider Name | JAMES ALLAN BERG JR. P.T.
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Gender | Male
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 280 E LOSEY ST
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City | GALESBURG
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State | IL
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Zip | 61401-2819
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Country | US
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Telephone | 309-343-2166
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Fax |
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Provider Business Mailing Address
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Address Line | 902 IOWA DR
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City | LE CLAIRE
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State | IA
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Zip | 52753-9814
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Country | US
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Telephone | 563-289-1349
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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 | 070014492
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License Number State | IL
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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 | 03314
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License Number State | IA
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