Provider Demographics
NPI:1588633978
Name:HOGLUND-BERGHAN, ASA (RPTL)
Entity Type:Individual
Prefix:MRS
First Name:ASA
Middle Name:
Last Name:HOGLUND-BERGHAN
Suffix:
Gender:F
Credentials:RPTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 GOLANSKY BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192
Mailing Address - Country:US
Mailing Address - Phone:703-580-5183
Mailing Address - Fax:703-580-5186
Practice Address - Street 1:3135 GOLANSKY BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:703-580-5183
Practice Address - Fax:703-580-5186
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W107U39Medicare ID - Type Unspecified