Individual
BERGAN JAYDE JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3000 RISEN SON BLVD, COUNCIL BLUFFS, IA 51503-1911
(712) 366-9655
Mailing address
2396 SHARON AVE, LOGAN, IA 51546-5028
(712) 592-3358
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
110375
IA
Other
Enumeration date
09/16/2021
Last updated
09/16/2021
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