| Doctor Name: | DIANA L BERGBAUER |
| NPI Number: | 1063758969 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | PT002558E |
| Business Practice Address: | 209 Martins Ln Media, PA - 190635854 |
| Business Phone Number: | 6106535190 |
| Business Fax Number: | |
| Mailing Address: | 209 Martins Ln, MEDIA |
| State: | PA |
| Postal Code: | 190635854 |
| Phone Number: | 6106535190 |
| Fax Number: | |
| NPI Enumeration Date: | 12/20/2012 |
| NPI Last Update Date: | 12/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | PT002558E |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |