Brandon Berg, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

3156-19 Issued in WA

Practice address

4303 W 24TH Ave
Kennewick, WA 99338-1963

Phone

(509) 572-3836

NPI assigned

Mar 26, 2024

Last updated

Mar 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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": "1711411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1629828165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 S WILLOW ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031035714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4303 W 24TH AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993381963",
            "telephone_number": "509-572-3836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERG",
        "first_name": "BRANDON",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "3156-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benton Franklin District Health Department
• Benton Franklin Orthopedic Associates, PLLC
• Benton-Franklin Community Health Alliance (Alliance Consistent Care Program)
• Benton-Franklin Counties-Crisis Reponse Unit
• Benton/Franklin County Crisis Response Unit
• Gerald F Berges, O.D.
• Adriann Bergman
• Dana Michelle Berkey
• Bethany Dawn Berklund
• Amanda Bernert

• Physical Therapy Assistant in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.