Provider Demographics
NPI:1801137799
Name:BERGSTRESSER, DIANA (LMT, CNMT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:BERGSTRESSER
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15020 ALBRITTON RD
Mailing Address - Street 2:
Mailing Address - City:MYAKKA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34251-8940
Mailing Address - Country:US
Mailing Address - Phone:941-356-0339
Mailing Address - Fax:
Practice Address - Street 1:5899 WHITFIELD AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-6152
Practice Address - Country:US
Practice Address - Phone:941-356-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 58178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist