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General NPI Number Information
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NPI Number | 1861436370
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Entity Type | Individual
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Provider Name | KEN M BERGER L.M.P.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 6523 21ST AVE NE SUITE 3
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City | SEATTLE
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State | WA
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Zip | 98115-6924
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Country | US
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Telephone | 206-931-6578
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15857
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City | SEATTLE
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State | WA
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Zip | 98115-0857
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Country | US
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Telephone | 206-931-6578
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA7546
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License Number State | WA
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