Provider Demographics
NPI:1952783292
Name:BERGMANN, DREW HAROLD (ATC, OEC)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:HAROLD
Last Name:BERGMANN
Suffix:
Gender:M
Credentials:ATC, OEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 AVALANCHE CIR
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:CO
Mailing Address - Zip Code:80435-7643
Mailing Address - Country:US
Mailing Address - Phone:516-732-0256
Mailing Address - Fax:
Practice Address - Street 1:42 AVALANCHE CIR
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:CO
Practice Address - Zip Code:80435-7643
Practice Address - Country:US
Practice Address - Phone:516-732-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.0001208390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program