Provider Demographics
NPI:1699742775
Name:BERG, KAREN CHRISTINE (PT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:CHRISTINE
Last Name:BERG
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 1:103 DRAPER LN
Mailing Address - Street 2:
Mailing Address - City:BERTRAM
Mailing Address - State:TX
Mailing Address - Zip Code:78605-2038
Mailing Address - Country:US
Mailing Address - Phone:586-214-8924
Mailing Address - Fax:
Practice Address - Street 1:1616 AZALEA DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2774
Practice Address - Country:US
Practice Address - Phone:254-771-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004091225100000X
TX1368821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist