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NPI Code Detail

MEDICARE: KIRSTIN ULLA BERGMAN P.T.

MEDICARE: KIRSTIN ULLA BERGMAN 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
1225100000XPhysical Therapist6456MN

General Provider Information

NPI Number : 1548491897
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTIN ULLA BERGMAN P.T.
Provider Business Mailing Address
First Line : 515 19TH AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-5274
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 515 19TH AVE SW
Second Line :
City : WILLMAR
State : MN
Zip : 56201-5274
Country : US
Telephone Number : 320-235-2720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2009
Last Update Date : 08/04/2009

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