Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1174351 | TX |
NPI | 1063825859 |
---|---|
Provider Name | Jennifer Bergman |
First Address | Hurst, TX 76053-7209 |
Second Address | Hurst, TX 76053-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 09/06/2014 |