Provider Demographics
NPI:1730552878
Name:BERBER, BJORN CARLO (PT)
Entity type:Individual
Prefix:
First Name:BJORN CARLO
Middle Name:
Last Name:BERBER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 HARMONY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-8665
Mailing Address - Country:US
Mailing Address - Phone:931-261-6676
Mailing Address - Fax:
Practice Address - Street 1:2911 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4316
Practice Address - Country:US
Practice Address - Phone:812-941-9893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011698A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist