Provider Demographics
NPI:1235102997
Name:VANDEN BERGH, MARGARET R (PT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:R
Last Name:VANDEN BERGH
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:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:VT
Mailing Address - Zip Code:05149-0262
Mailing Address - Country:US
Mailing Address - Phone:802-228-4840
Mailing Address - Fax:802-228-2889
Practice Address - Street 1:60 BIXBY ROAD
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:VT
Practice Address - Zip Code:05149
Practice Address - Country:US
Practice Address - Phone:802-228-4840
Practice Address - Fax:802-228-2889
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
040 0000933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTVN 0605Medicare ID - Type Unspecified