MEDICARE: JENNIFER BERGER LMT

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	225700000X	Massage Therapist	MT.0013892	CO

General Provider Information

NPI Number	:	1831795939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BERGER LMT

Provider Business Mailing Address
First Line	:	10346 ABRAMS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-8409
Country	:	US
Telephone Number	:	970-232-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2960 N ACADEMY BLVD STE 207
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5303
Country	:	US
Telephone Number	:	719-593-0055
Fax Number	:

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

Provider Enumeration Date	:	12/05/2020
Last Update Date	:	12/05/2020

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