Provider Demographics
NPI:1235135872
Name:BERGER, DEBRA (PT)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:BERGER
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 1:1280 N MILDRED RD
Mailing Address - Street 2:STE 2
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-2212
Mailing Address - Country:US
Mailing Address - Phone:970-564-0311
Mailing Address - Fax:970-564-0313
Practice Address - Street 1:1280 N MILDRED RD
Practice Address - Street 2:STE 2
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-2212
Practice Address - Country:US
Practice Address - Phone:970-564-0311
Practice Address - Fax:970-564-0313
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62371240Medicaid
CO499838Medicare UPIN