Active NPI
Audrey Bergen, PT
- Geriatric Physical Therapist
- Chelsea, MI
National Provider Identifier
1801386479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 5501006759
- Practice address
- 775 S Main St
Chelsea, MI 48118-1383 - Phone
- (734) 593-5620
- NPI assigned
- May 18, 2018
- Last updated
- May 18, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 5501006759 | MI | Primary |
Addresses
Primary practice location
775 S Main St
Chelsea, MI 48118-1383
Mailing address
34505 W 12 Mile Rd Ste 200
Farmington Hills, MI 48331-3286
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501006759 | MI | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1526601600000",
"number": "1801386479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34505 W 12 MILE RD STE 200",
"city": "FARMINGTON HILLS",
"state": "MI",
"postal_code": "483313286"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 S MAIN ST",
"city": "CHELSEA",
"state": "MI",
"postal_code": "481181383",
"telephone_number": "734-593-5620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGEN",
"first_name": "AUDREY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-05-18",
"last_updated": "2018-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "MI",
"license": "5501006759",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chelsea, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.