Provider Demographics
NPI:1043857428
Name:BERGSTROM, MICHELE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:BERGSTROM
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2332
Mailing Address - Country:US
Mailing Address - Phone:617-851-7685
Mailing Address - Fax:
Practice Address - Street 1:43 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2332
Practice Address - Country:US
Practice Address - Phone:617-851-7685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist