Individual
MR. FREDERICK WILLIAM BERGGREN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA, ATC
Contact information
Practice address
495 GOLD STAR HWY, SUITE112, GROTON, CT 06340-6228
(860) 446-8254
(860) 446-8293
Mailing address
21 RIDGE RD, PO BOX 3457, GROTON, CT 06340-8928
(860) 536-8675
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1133
CT
2255A2300X
Athletic Trainer
000393
CT
Other
Enumeration date
03/30/2007
Last updated
11/23/2010
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