Provider Demographics
NPI:1588915623
Name:BERGER, LESLEY L (PT)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:L
Last Name:BERGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SW BONNETT WAY
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3205
Mailing Address - Country:US
Mailing Address - Phone:541-797-6316
Mailing Address - Fax:541-797-6319
Practice Address - Street 1:730 SW BONNETT WAY
Practice Address - Street 2:SUITE 3100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3205
Practice Address - Country:US
Practice Address - Phone:541-797-6316
Practice Address - Fax:541-797-6319
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500650825Medicaid
ORR166767Medicare PIN