Provider Demographics
NPI:1588000582
Name:BERGER, KIRSTIN ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:ANN
Last Name:BERGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 E 53RD ST # 2A-2B
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2613
Mailing Address - Country:US
Mailing Address - Phone:563-468-3727
Mailing Address - Fax:
Practice Address - Street 1:960 E 53RD ST # 2A-2B
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2613
Practice Address - Country:US
Practice Address - Phone:563-468-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070021460225100000X
IA005103225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist