Doctor Name: | JENNIFER BERGMAN |
NPI Number: | 1063825859 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT, MSPT |
License Number: | 1174351 |
Business Practice Address: | 305 Ne Loop 820 Business Tower 1, Suite 200 Hurst, TX - 760537209 |
Business Phone Number: | 8172928787 |
Business Fax Number: | 8177896849 |
Mailing Address: | 305 Ne Loop 820, Business Tower 1, Suite 200 HURST |
State: | TX |
Postal Code: | 760537209 |
Phone Number: | 8172928787 |
Fax Number: | 8177896849 |
NPI Enumeration Date: | 06/09/2014 |
NPI Last Update Date: | 06/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251P0200X |
License Number: | 1174351 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |