Individual
TADD WILLIAM BERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2030 14TH ST BLDG 1830, FORT POLK, LA 71459-5302
(337) 718-2913
Mailing address
7910 DESTINY BLVD, FORT CAMPBELL, KY 42223
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3277
TN
Other
Enumeration date
09/09/2020
Last updated
11/17/2025
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