MEDICARE: MS. MARCIA RONNIE BERGER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0507	AZ

General Provider Information

NPI Number	:	1093202756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA RONNIE BERGER PT

Provider Business Mailing Address
First Line	:	2520 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-4324
Country	:	US
Telephone Number	:	520-622-4100
Fax Number	:	520-624-0303

Provider Business Practice Location Address
First Line	:	2520 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-4324
Country	:	US
Telephone Number	:	520-622-4100
Fax Number	:	520-624-0303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2018
Last Update Date	:	04/18/2018

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