Provider Demographics
NPI:1750528600
Name:BERG, JAMES ALLAN JR (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLAN
Last Name:BERG
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 1:902 IOWA DR
Mailing Address - Street 2:
Mailing Address - City:LE CLAIRE
Mailing Address - State:IA
Mailing Address - Zip Code:52753-9814
Mailing Address - Country:US
Mailing Address - Phone:563-289-1349
Mailing Address - Fax:
Practice Address - Street 1:280 E LOSEY ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2819
Practice Address - Country:US
Practice Address - Phone:309-343-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014492225100000X
IA03314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist