Frederick William Berggren Jr., PTA, ATC

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

1133 Issued in CT

Practice address

495 Gold Star Hwy
Suite112
Groton, CT 06340-6228

Phone

(860) 446-8254

Fax

(860) 446-8293

NPI assigned

Mar 30, 2007

Last updated

Nov 23, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290470400000",
    "number": "1245350537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 RIDGE RD",
            "address_2": "PO BOX 3457",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063408928",
            "telephone_number": "860-536-8675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 GOLD STAR HWY",
            "address_2": "SUITE112",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406228",
            "telephone_number": "860-446-8254",
            "fax_number": "860-446-8293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGGREN",
        "first_name": "FREDERICK",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PTA,  ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2010-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CT",
            "license": "1133",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "CT",
            "license": "000393",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Deane Baxley, LCSW
• Rashad Lamar Beamon, IDC
• Kelley Bean
• Nicholas David Becker
• Matthew Benjamin
• Andrew James Bergmann, DDS
• Peter Paul Bertolozzi Jr., D.O.
• Best Health Physical Therapy, LLC (Best Health Physical Therapy)
• Nancy Ann Bestwick, COTA
• Bethany Ackley LCSW, LLC

• Physical Therapy Assistant in Groton, CT
• Providers in Groton, CT by specialty
• Physical Therapy Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.