Provider Demographics
NPI:1881397313
Name:BERGQUIST, TAYLOR (LAT, ATC, MDNC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BERGQUIST
Suffix:
Gender:F
Credentials:LAT, ATC, MDNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34601 93RD ST NE
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ND
Mailing Address - Zip Code:58579-9722
Mailing Address - Country:US
Mailing Address - Phone:701-989-0160
Mailing Address - Fax:
Practice Address - Street 1:5802 RIDGELAND DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6189
Practice Address - Country:US
Practice Address - Phone:701-223-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
ND983-242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer