Kim Bergh, PTA

Key facts

NPI

1417296237

Entity type

Individual (NPI type 1)

Primary specialty

Physical Therapy Assistant 225200000X

License

1724-019 (WI)

Practice address

320 N 7TH St
Cornell, WI 54732-8120

Phone

(715) 239-0440

Fax

(715) 239-6608

NPI assigned

Feb 14, 2013

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 14, 2013.

{
    "created_epoch": "1360800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360800000000",
    "number": "1417296237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "E8625 595TH AVE",
            "city": "ELK MOUND",
            "state": "WI",
            "postal_code": "547399037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N 7TH ST",
            "city": "CORNELL",
            "state": "WI",
            "postal_code": "547328120",
            "telephone_number": "715-239-0440",
            "fax_number": "715-239-6608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGH",
        "first_name": "KIM",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-14",
        "last_updated": "2013-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1724-019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cornell, WI

• Janis Cekan, APNP
• Cornell Area Ambulance Service
• Cornell Chiropractic, LLC
• Cornell Pharmacy, Inc.
• Cornell School District

All providers in Cornell, WI · Physical Therapy Assistant in Wisconsin