Provider Demographics
NPI:1790164416
Name:BERGEN, AARON PAUL (DPT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:PAUL
Last Name:BERGEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:2001 N STATE ROUTE 7
Practice Address - Street 2:STE B
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-9303
Practice Address - Country:US
Practice Address - Phone:816-987-7049
Practice Address - Fax:816-987-2606
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO225100000X
COPTL.0013315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist