Provider Demographics
NPI:1871620054
Name:BERGERT, NED HARLOW (MS ATC PTA)
Entity type:Individual
Prefix:MR
First Name:NED
Middle Name:HARLOW
Last Name:BERGERT
Suffix:
Gender:M
Credentials:MS ATC PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GENE AUTRY WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2000
Mailing Address - Country:US
Mailing Address - Phone:714-940-2043
Mailing Address - Fax:714-940-2240
Practice Address - Street 1:2000 E GENE AUTRY WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-6143
Practice Address - Country:US
Practice Address - Phone:714-940-2043
Practice Address - Fax:714-940-2240
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT2979225200000X
AZ03622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer