Provider Demographics
NPI:1407875370
Name:BERG, JAMES PATRICK (MSPT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:BERG
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22 JENSEN FARM RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-2723
Mailing Address - Country:US
Mailing Address - Phone:203-881-0618
Mailing Address - Fax:
Practice Address - Street 1:340 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5445
Practice Address - Country:US
Practice Address - Phone:203-362-2400
Practice Address - Fax:203-373-1286
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist