Provider Demographics
NPI:1861869018
Name:BERG, BREANNA M (DPT)
Entity type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:M
Last Name:BERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 PECK ROAD
Mailing Address - Street 2:BUILDING #1; SUITE 1101
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790
Mailing Address - Country:US
Mailing Address - Phone:860-489-0867
Mailing Address - Fax:860-489-4473
Practice Address - Street 1:30 PECK ROAD
Practice Address - Street 2:BUILDING #1; SUITE 1101
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-489-0867
Practice Address - Fax:860-489-4473
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist