Provider Demographics
NPI:1518360387
Name:BERGER, NIKOLAUS D
Entity Type:Individual
Prefix:
First Name:NIKOLAUS
Middle Name:D
Last Name:BERGER
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 1:5531 DOROTHY CT
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:OH
Mailing Address - Zip Code:45005-4167
Mailing Address - Country:US
Mailing Address - Phone:937-272-1181
Mailing Address - Fax:
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-438-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-15782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer