Provider Demographics
NPI:1811323512
Name:BERGER, ANDREA J (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BERGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:J
Other - Last Name:MALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:333 8TH ST SE
Mailing Address - Street 2:APT 112
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1267
Mailing Address - Country:US
Mailing Address - Phone:414-559-3280
Mailing Address - Fax:
Practice Address - Street 1:4670 PARK NICOLLET AVE SE
Practice Address - Street 2:REHABILITATION SERVICES
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4119
Practice Address - Country:US
Practice Address - Phone:952-993-8845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist