Provider Demographics
NPI:1033714126
Name:BERGER, KATHRYN (MA, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BERGER
Suffix:
Gender:F
Credentials:MA, LAT, ATC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:STAIERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LAT, ATC
Mailing Address - Street 1:1 ELLIOT DR. CARVER HAWKEYE ARENA
Mailing Address - Street 2:ATHLETIC TRAINING S181
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT DR. CARVER HAWKEYE ARENA
Practice Address - Street 2:ATHLETIC TRAINING S181
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-335-9396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0011682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA001168OtherSTATE OF IOWA DEPARTMENT OF PUBLIC HEALTH
NE2000013252OtherBOC CERTIFIED ATHLETIC TRAINER