Provider Demographics
NPI:1073130670
Name:BERGMAN, HEIDI KATHRYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KATHRYN
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:KATHRYN
Other - Last Name:BOHRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:1731 SUNNYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-3465
Mailing Address - Country:US
Mailing Address - Phone:920-676-9514
Mailing Address - Fax:
Practice Address - Street 1:3117 SHORE DR STE 101
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4293
Practice Address - Country:US
Practice Address - Phone:715-732-5111
Practice Address - Fax:715-732-8220
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15011-242251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100100866Medicaid