Provider Demographics
NPI:1669932273
Name:BERGH, TAYLOR ALEXANDRA (MA, ATC)
Entity type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:ALEXANDRA
Last Name:BERGH
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W 44TH PL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6376
Mailing Address - Country:US
Mailing Address - Phone:605-322-3278
Mailing Address - Fax:
Practice Address - Street 1:3201 S KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4296
Practice Address - Country:US
Practice Address - Phone:605-999-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD04572255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer