Provider Demographics
NPI:1578451373
Name:VON BERGEN, SYDNEY SHEA (ATS)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SHEA
Last Name:VON BERGEN
Suffix:
Gender:F
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 PATTEE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1621
Mailing Address - Country:US
Mailing Address - Phone:406-366-5984
Mailing Address - Fax:
Practice Address - Street 1:512 PATTEE CANYON DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1621
Practice Address - Country:US
Practice Address - Phone:406-366-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS