Provider Demographics
NPI:1063957710
Name:VAN DEN BERG, CARRIE (DPT)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:VAN DEN BERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8765
Mailing Address - Country:US
Mailing Address - Phone:336-675-2398
Mailing Address - Fax:
Practice Address - Street 1:2579 ERIC LN
Practice Address - Street 2:UNIT K
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5587
Practice Address - Country:US
Practice Address - Phone:336-270-5304
Practice Address - Fax:336-270-4158
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP10995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist