Provider Demographics
NPI:1659618676
Name:BERGWALL, REBECCA K (PT)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:K
Last Name:BERGWALL
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 1:850 E CIMARRON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4531
Mailing Address - Country:US
Mailing Address - Phone:352-682-9009
Mailing Address - Fax:
Practice Address - Street 1:850 E CIMARRON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4531
Practice Address - Country:US
Practice Address - Phone:352-682-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist