| Doctor Name: | ANDREW MICHAEL BERGERON |
| NPI Number: | 1760809347 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | 08764R |
| Business Practice Address: | 120 White Rose Dr Raceland, LA - 703942644 |
| Business Phone Number: | 9855329662 |
| Business Fax Number: | 9855323942 |
| Mailing Address: | 8823 Production Ln, OOLTEWAH |
| State: | TN |
| Postal Code: | 373636511 |
| Phone Number: | 4232387217 |
| Fax Number: | 4232383473 |
| NPI Enumeration Date: | 03/21/2014 |
| NPI Last Update Date: | 12/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 08764R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |