Provider Demographics
NPI:1295762763
Name:BERGER, RONALD C JR (PT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:C
Last Name:BERGER
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12421 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2680
Mailing Address - Country:US
Mailing Address - Phone:904-292-0195
Mailing Address - Fax:904-292-0566
Practice Address - Street 1:12421 SAN JOSE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2680
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:904-292-0566
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699778001OtherCIGNA
7865018OtherAETNA
2157824OtherAETNA
2157824OtherAETNA