Provider Demographics
NPI:1285061390
Name:BERGERON, PATRICK RYAN
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:BERGERON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W SIERRA MADRE AVE
Mailing Address - Street 2:#33
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-1872
Mailing Address - Country:US
Mailing Address - Phone:360-907-9827
Mailing Address - Fax:
Practice Address - Street 1:900 W SIERRA MADRE AVENUE
Practice Address - Street 2:#33
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702
Practice Address - Country:US
Practice Address - Phone:360-907-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic