Provider Demographics
NPI:1518181338
Name:BERGER, JEREMY C (PT, MPT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:C
Last Name:BERGER
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 7TH ST W UNIT 1714
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34220-7069
Mailing Address - Country:US
Mailing Address - Phone:410-371-1342
Mailing Address - Fax:
Practice Address - Street 1:1299 BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3152
Practice Address - Country:US
Practice Address - Phone:941-951-0283
Practice Address - Fax:941-951-0283
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008896L89Medicare PIN
VA008896L89Medicare ID - Type UnspecifiedPROVIDER NUMBER