Provider Demographics
NPI:1659091353
Name:BERGER, ROGER WILLIAM (LPTA)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:WILLIAM
Last Name:BERGER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7595 BAYMEADOWS CIR W APT 1402
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1857
Mailing Address - Country:US
Mailing Address - Phone:904-790-0057
Mailing Address - Fax:
Practice Address - Street 1:7595 BAYMEADOWS CIR W APT 1402
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1857
Practice Address - Country:US
Practice Address - Phone:904-790-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30525225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant