Provider Demographics
NPI:1649243015
Name:BERG, DARANEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DARANEE
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DARANEE
Other - Middle Name:
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:660 E FRANKLIN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2912
Mailing Address - Country:US
Mailing Address - Phone:208-895-2393
Mailing Address - Fax:208-895-2641
Practice Address - Street 1:660 E FRANKLIN RD STE 110
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2912
Practice Address - Country:US
Practice Address - Phone:208-895-2393
Practice Address - Fax:208-895-2641
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010153089OtherBLUE CROSS OF IDAHO
IDTD322OtherBLUE CROSS OF IDAHO
ID807326600Medicaid
ID000010153089OtherBLUE CROSS OF IDAHO