MEDICARE: MS. DEBRA BERGER P.T.

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	8305	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235135872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA BERGER P.T.

Provider Business Mailing Address
First Line	:	1280 N MILDRED RD
Second Line	:	STE 2
City	:	CORTEZ
State	:	CO
Zip	:	81321-2212
Country	:	US
Telephone Number	:	970-564-0311
Fax Number	:	970-564-0313

Provider Business Practice Location Address
First Line	:	1280 N MILDRED RD
Second Line	:	STE 2
City	:	CORTEZ
State	:	CO
Zip	:	81321-2212
Country	:	US
Telephone Number	:	970-564-0311
Fax Number	:	970-564-0313

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/17/2015

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