Organization
EVOLVE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERI L BERGERON MSPT (PHYSICAL THERAPIST, REGISTERED AGEN)
(970) 470-2611
Entity
Organization
Contact information
Practice address
137 MAIN ST, G-001, EDWARDS, CO 81632-8118
(970) 470-2611
Mailing address
137 MAIN ST, G-001, EDWARDS, CO 81632-8118
(970) 470-2611
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
8661
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97734543
—
CO
Enumeration date
09/05/2008
Last updated
09/05/2008
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