Provider Demographics
NPI:1912245457
Name:JAMIE BERGENFELD, P.T.,INC.
Entity Type:Organization
Organization Name:JAMIE BERGENFELD, P.T.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-252-4744
Mailing Address - Street 1:3185 HARTRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3431
Mailing Address - Country:US
Mailing Address - Phone:561-252-4744
Mailing Address - Fax:
Practice Address - Street 1:3185 HARTRIDGE TER
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3431
Practice Address - Country:US
Practice Address - Phone:561-252-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886295800Medicaid