Provider Demographics
NPI:1205557071
Name:BERGAL, SHANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:BERGAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15650 CROWNRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4821
Mailing Address - Country:US
Mailing Address - Phone:818-730-1525
Mailing Address - Fax:
Practice Address - Street 1:1154 E MAIN ST STE 106
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-7169
Practice Address - Country:US
Practice Address - Phone:619-486-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic