Provider Demographics
NPI:1568447373
Name:BERGER, GREGORY (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:BERGER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02121-4308
Mailing Address - Country:US
Mailing Address - Phone:617-516-8005
Mailing Address - Fax:617-516-8599
Practice Address - Street 1:440 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02121-4308
Practice Address - Country:US
Practice Address - Phone:617-516-8005
Practice Address - Fax:617-516-8599
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL11182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist