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MR. FREDRICK R BERGEN LMT
>> Massage Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1750450722
Individual Registrant:MR. FREDRICK R BERGEN LMT
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
120 S PALM AVE PALATKA, FL 32177-4140 US
Tel: 386-325-3500 Fax: --
Tel: 386-325-3500 Fax: --
Contact information for business:
251 FEDERAL POINT RD EAST PALATKA, FL 32131-4329 US
Tel: 386-328-2225 Fax: --
Tel: 386-328-2225 Fax: --
Registration Information:
NPI: 1750450722
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Massage Therapist | FL | 46239 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
