Provider Demographics
NPI:1265899603
Name:BERGMANN, LESLIE C (PT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:BERGMANN
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:PO BOX 2102
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20847-2102
Mailing Address - Country:US
Mailing Address - Phone:301-613-9252
Mailing Address - Fax:
Practice Address - Street 1:133 ROLLINS AVE
Practice Address - Street 2:UNIT 4A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4040
Practice Address - Country:US
Practice Address - Phone:301-613-9252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181972251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic