Provider Demographics
NPI:1609065499
Name:BERG, KAREN JANICE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JANICE
Last Name:BERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 IOWA DR
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9814
Mailing Address - Country:US
Mailing Address - Phone:563-289-1349
Mailing Address - Fax:563-289-2890
Practice Address - Street 1:902 IOWA DR
Practice Address - Street 2:
Practice Address - City:LE CLAIRE
Practice Address - State:IA
Practice Address - Zip Code:52753-9814
Practice Address - Country:US
Practice Address - Phone:563-289-1349
Practice Address - Fax:563-289-2890
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03131225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist