Provider Demographics
NPI:1477255719
Name:BERTMAN, ALEX JAMES
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JAMES
Last Name:BERTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21684 STATE HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-6164
Mailing Address - Country:US
Mailing Address - Phone:618-558-2858
Mailing Address - Fax:
Practice Address - Street 1:1001 S STATE ST
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2361
Practice Address - Country:US
Practice Address - Phone:618-558-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist