Provider Demographics
NPI:1902884588
Name:ASARO, JAMIE BERGENFELD (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:BERGENFELD
Last Name:ASARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:BERGENFELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3185 HARTRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3431
Mailing Address - Country:US
Mailing Address - Phone:561-252-4744
Mailing Address - Fax:
Practice Address - Street 1:119 HAMILTON TER
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4339
Practice Address - Country:US
Practice Address - Phone:561-793-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL16205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886295800Medicaid