Provider Demographics
NPI:1699875757
Name:BERG, PAUL ARTHUR JR (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ARTHUR
Last Name:BERG
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 HERITAGE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW PRAGUE
Mailing Address - State:MN
Mailing Address - Zip Code:56071-2200
Mailing Address - Country:US
Mailing Address - Phone:952-758-7014
Mailing Address - Fax:
Practice Address - Street 1:1400 1ST ST NE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2215
Practice Address - Country:US
Practice Address - Phone:952-758-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN14N36BEOtherMN BLUE CROSS BLUE SHIELD