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MR. FREDRICK R BERGEN LMT

>> Massage Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1750450722

Individual Registrant:
MR. FREDRICK R BERGEN LMT
Gender: M
Sole Proprietor

Location and contact information for practice:
120 S PALM AVE  PALATKA, FL 32177-4140 US
Tel: 386-325-3500  Fax: --

Contact information for business:
251 FEDERAL POINT RD  EAST PALATKA, FL 32131-4329 US
Tel: 386-328-2225  Fax: --

Registration Information:
NPI: 1750450722
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y225700000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Massage Therapist
FL46239

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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