Provider Demographics
NPI:1588217293
Name:BERG, SARA LEAH (DPT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LEAH
Last Name:BERG
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 1:23 ROBERT PITT DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3372
Mailing Address - Country:US
Mailing Address - Phone:845-517-2652
Mailing Address - Fax:
Practice Address - Street 1:23 ROBERT PITT DR STE 110
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3372
Practice Address - Country:US
Practice Address - Phone:845-517-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042578-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist