MEDICARE: GREGORY 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	PTL11182	MA

General Provider Information

NPI Number	:	1568447373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BERGER PT

Provider Business Mailing Address
First Line	:	440 BLUE HILL AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-4308
Country	:	US
Telephone Number	:	617-516-8005
Fax Number	:	617-516-8599

Provider Business Practice Location Address
First Line	:	440 BLUE HILL AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-4308
Country	:	US
Telephone Number	:	617-516-8005
Fax Number	:	617-516-8599

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/15/2025

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