Provider Demographics
NPI:1225872872
Name:BERG, ANNA MARIE (ATC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BERG
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51346-7645
Mailing Address - Country:US
Mailing Address - Phone:507-766-4322
Mailing Address - Fax:
Practice Address - Street 1:1900 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2200
Practice Address - Country:US
Practice Address - Phone:712-262-7141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1144112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer