Fay Ann Bergeron, RPT

Individual provider Active NPI Physical Therapist · Valrico, FL

NPI 1932397809 · NPPES record last updated Jul 3, 2018

Key facts

NPI
1932397809
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
PT13795 (FL)
Practice address
2530 Ridgetop Way
Valrico, FL 33594
Phone
(813) 684-9985
Fax
(813) 655-2622
NPI assigned
Oct 4, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PT13795FLMDPhysical Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X
Physical Therapist 225100000X PT13795 FL Yes

Addresses

Primary practice location

2530 Ridgetop Way
Valrico, FL 33594

Mailing address

2208 Dumbarton Way
Valrico, FL 33594-4117
Phone (813) 684-4520

Other providers in Valrico, FL

All providers in Valrico, FL · Physical Therapist in Florida

Sources for this page

Verify at the official NPI Registry.