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General NPI Number Information
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NPI Number | 1962978700
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Entity Type | Individual
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Provider Name | LUKE DEREK CASONA BERDIN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 01/28/2022
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Provider Practice Location Address
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Address Line | 717 E ALFRED ST, WEYAUWEGA, WI 54983
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City | WEYAUWEGA
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State | WI
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Zip | 54983
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Country | US
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Telephone | 920-867-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 1336 STONE RIDGE RD APT 57
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City | WAUPACA
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State | WI
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Zip | 54981-8639
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Country | US
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Telephone | 929-273-9321
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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 | 14132-24
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License Number State | WI
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