Individual
BLAIR GLEE BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
3131 WESTERN AVE, KINGMAN, AZ 86401-0951
(928) 718-0718
Mailing address
PO BOX 818, MEADVIEW, AZ 86444-0818
(928) 564-2866
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5980
AZ
Other
Enumeration date
07/08/2009
Last updated
07/08/2009
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