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General NPI Number Information
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NPI Number | 1780574228
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Entity Type | Individual
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Provider Name | JAREK BERG
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 10101 S 27TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-7209
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Country | US
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Telephone | 414-325-4850
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Fax |
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Provider Business Mailing Address
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Address Line | 3704 S 69TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53220-1813
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Country | US
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Telephone |
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 16753-24
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License Number State | WI
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