Provider Demographics
NPI:1144335837
Name:BERG, ANDREA (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 S TABOR WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4757
Mailing Address - Country:US
Mailing Address - Phone:303-320-4450
Mailing Address - Fax:303-320-6668
Practice Address - Street 1:400 S COLORADO BLVD
Practice Address - Street 2:STE 640
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1253
Practice Address - Country:US
Practice Address - Phone:303-320-4450
Practice Address - Fax:303-320-6668
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist