Individual
KATHERINE MARIAH BERGLUND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MAT, ATC, LAT
Contact information
Practice address
3302 VALENCIA DR, IDAHO FALLS, ID 83404-7058
(208) 352-2584
Mailing address
3302 VALENCIA DR, IDAHO FALLS, ID 83404-7058
(208) 352-2584
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
884-20
ND
2255A2300X
Athletic Trainer
Primary
AT-776
ID
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
07/03/2018
Last updated
09/21/2022
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