Provider Demographics
NPI:1326818741
Name:BERGMAN, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:PROKOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:680 KINGSBOROUGH SQ STE C
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4988
Mailing Address - Country:US
Mailing Address - Phone:757-410-5322
Mailing Address - Fax:757-548-0670
Practice Address - Street 1:680 KINGSBOROUGH SQ STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4988
Practice Address - Country:US
Practice Address - Phone:757-410-5322
Practice Address - Fax:757-548-0670
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist