Individual
KEVIN P BERGHORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
360 N MAIN ST STE 9, COMMUNITY PHYSICAL THERAPY, SOUTHINGTON, CT 06489-2503
(860) 621-7389
(860) 621-7389
Mailing address
360 N MAIN ST STE 9, COMMUNITY PHYSICAL THERAPY, SOUTHINGTON, CT 06489-2503
(860) 621-7389
(860) 621-7389
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
9667
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009667
CT STATE LICENSE
CT
Enumeration date
02/07/2013
Last updated
08/12/2013
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