Organization
VITAM PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY MARIE BERG DPT,MS,CSCS, FAFS (OWNER)
(208) 830-1668
Entity
Organization
Contact information
Practice address
3858 N GARDEN CENTER WAY, SUITE 102, BOISE, ID 83703-5008
(208) 830-1668
Mailing address
3858 N GARDEN CENTER WAY, SUITE 102, BOISE, ID 83703-5008
(208) 830-1668
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT-2717
ID
Other
Enumeration date
06/14/2013
Last updated
06/04/2014
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